Whiteside-Yim C, Mac Adams M R
Postgrad Med. 1987 Apr;81(5):231-5, 238-40, 245. doi: 10.1080/00325481.1987.11699798.
A variety of thyroid abnormalities are commonly seen in clinical practice and can in many cases be accurately diagnosed and managed by the primary care physician. In patients with hypothyroidism and hyperthyroidism, classic features are usually present, but in some, particularly the elderly, the conditions present atypically. In addition, several other conditions can mimic thyroid problems, and a number of drugs can alter thyroxine levels or actual thyroid function. Laboratory measurements, including serum thyrotropin and thyroxine levels and triiodothyronine uptake, may be helpful in diagnosis. Drug therapy is indicated in most cases, and surgery is necessary in some. Thyroiditis can be of the subacute or chronic type. Aspirin, propranolol (Inderal), and occasionally glucocorticoids are used in the former. Therapy in the latter depends on results of thyroid function tests. In cases involving thyroid nodules, radioactive iodine screening and fine-needle aspiration are useful diagnostically. In patients with possible malignancy, surgery is indicated. Patients who have benign lesions are treated with thyroid hormone-suppressive therapy.
临床实践中常见多种甲状腺异常情况，在许多病例中，初级保健医生能够准确诊断并进行处理。甲状腺功能减退和甲状腺功能亢进患者通常会出现典型症状，但部分患者，尤其是老年患者，症状可能不典型。此外，其他一些病症可能会与甲状腺问题相似，多种药物也可能改变甲状腺素水平或实际甲状腺功能。实验室检测，包括血清促甲状腺激素、甲状腺素水平及三碘甲状腺原氨酸摄取量检测，可能有助于诊断。多数情况下需进行药物治疗，部分情况则需要手术治疗。甲状腺炎可分为亚急性或慢性类型。前者使用阿司匹林、普萘洛尔（心得安），偶尔使用糖皮质激素。后者的治疗取决于甲状腺功能测试结果。对于甲状腺结节病例，放射性碘筛查和细针穿刺抽吸在诊断上很有用。对于可能患有恶性肿瘤的患者，需进行手术治疗。患有良性病变的患者则采用甲状腺激素抑制疗法进行治疗。
