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患者,女,40岁,主因手指关节变形12年,伴甲状腺肿大4年住院。既往史及家族史无阳性记载。体格检查:发育正常。甲状腺Ⅱ—Ⅲ度肿大,左侧大于右侧。左侧质略硬,无压痛,可闻血管杂音,星结节状,质硬如橡皮,可触及桃核大小极硬的结节。双手掌指关节肿大,肌萎缩,四指均向尺侧偏斜。辅助检查:血TT_30.5ng/ml、TT_420ng/ml、TSH 13.0μlu/ml。甲状腺球蛋白抗体54％,甲状腺微粒体抗体46.8％,血沉40mm/h,类风湿因子阳性,甲状腺吸~(131)碘率3小时21.5％,24小时44.9％,甲状腺扫描,形态不规整,面积增
Patients, female, 40 years old, the main deformation of the fingers for 12 years, accompanied by goiter four years hospitalization. Past history and family history no positive records. Physical examination: normal development. Thyroid Ⅱ-Ⅲ degree enlargement, left greater than the right. The left side of the hard, no tenderness, can be heard vascular murmur, star nodular, hard as rubber, can reach extremely hard nuclei nodules. Two hands and fingers swollen joints, muscle atrophy, four fingers are to the ulnar deviation. Auxiliary examination: blood TT_30.5ng / ml, TT_420ng / ml, TSH 13.0μlu / ml. Thyroglobulin antibody 54%, thyroid microsomal antibody 46.8%, erythrocyte sedimentation rate 40mm / h, rheumatoid factor positive, thyroid suction 131I 3 hours 21.5%, 24 hours 44.9%, thyroid scan, irregular shape, area increase