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患者女性,29岁,公司职员。一个月前因怕热、心慌、手抖,体重下降,就诊于我内分泌门诊,查T3、T4高,TSH低,确定诊断为“弥漫性甲状腺肿并甲亢”,建议住院治疗,因经济条件差,拒绝住院,故门诊给予口服他吧唑片,10mg,3次／日,并嘱患者密切监测血常规,三天一次。患者曾复查血常规2次,均正常,未再监测。于服药第四周,即入院前四天受凉后出现发热、咽痛,门诊抗炎治疗无效,复查血常规,白细胞低：O．9×10e9／L,以“发热待查、粒细胞减少”于2004年4月12日收住。入院查体：T：39．7 C,P：120次/分,BP：120/80mmHg,全身皮肤黄染,浅表淋巴结未触及肿大。巩膜黄染,咽部充血,双侧扁桃体I度肿大,有脓性分泌物,甲状腺I度肿大,质韧,无压痛,随吞咽上下活动好,未闻及血管杂音。心、肺、腹未见异常。血常规：白细胞：0．7×10e9/L,粒细胞：0．2×10e9／1,红细胞：3．44×10e9/l,血红蛋白；92g/l,血小板：84．0×10e9/l。血清T3：3．1ng/ml,T4：149．5ng/ml,TSH：0．3uIU/ml；肝功能测定：白蛋白：34．6g/l,球蛋白37．9g/l,总胆红素高：165umol/l,直接胆红素109umol／l,间接胆红素56umol/1。肾功、肝炎病毒相关项目均正常。心电图提示：窦性心动过速。肝脏超声提示：肝回声增粗。骨髓穿刺结果：有核细胞、粒系、红系增生减低,淋巴系比值相对增高,形态未见异常,提示：再生障碍性贫血。
Patient female, 29 years old, company employee. A month ago because of fear of heat, palpitation, hand tremor, weight loss, treatment at my endocrine clinic, check T3, T4 high, TSH low, identified as “diffuse goiter and hyperthyroidism”, recommended hospitalization due to poor economic conditions , Refused to hospitalization, so give him an oral diazepam tablets, 10mg, 3 times / day, and Zhu Huanzhe close monitoring of blood, once every three days. Patients have reviewed the blood routine 2 times, were normal, no longer monitoring. In the fourth week of medication, four days before admission, there was fever and sore throat after the cold. Outpatient anti-inflammatory treatment was invalid. Blood routine examination and leukopenia were low. 9 × 10e9 / L, with “fever to be checked, neutropenia,” April 12, 2004 received. Admission examination: T: 39.7 C, P: 120 beats / min, BP: 120 / 80mmHg, body skin yellow dye, superficial lymph nodes did not touch swollen. Sclera yellow dye, throat congestion, bilateral tonsil I degree enlargement, purulent secretions, thyroid I degree enlargement, quality and toughness, no tenderness, with swallowing up and down activity is good, no smell and vascular murmur. Heart, lung, abdomen no exception. Blood: WBC: 0.7 × 10e9 / L, granulocyte: 0.2 × 10e9 / 1, erythrocytes: 3.44 × 10e9 / l, hemoglobin 92g / l, platelet: 84.0 × 10e9 / l. Serum T3: 3.1 ng / ml, T4: 149.5 ng / ml, TSH: 0.3 uIU / ml; liver function assay: albumin: 34.6 g / l, globulin 37.9 g / l, total bilirubin High: 165umol / l, direct bilirubin 109umol / l, indirect bilirubin 56umol / 1. Renal, hepatitis virus-related projects are normal. ECG tips: sinus tachycardia. Liver ultrasound tips: thickening of the liver echo. Bone marrow puncture results: nucleated cells, granulocytes, erythroid hyperplasia decreased lymphatic line relative ratio increased, no abnormal morphology, suggesting: aplastic anemia.