Ersoy Betül, Seniha Kiremitçi Yılmaz, Kızılay Deniz, Yılmaz Münevver, Coşkun Şenol
Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Celal Bayar University, Manisa, Turkey.
Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Celal Bayar University, Manisa, Turkey.
Ann Pediatr Endocrinol Metab. 2016 Sep;21(3):164-168. doi: 10.6065/apem.2016.21.3.164. Epub 2016 Sep 30.
Complex clinical presentation with diverse timing of particular symptoms may cause diagnostic difficulties, especially in children and adolescents. This paper presents diagnostic difficulties and pitfalls in 3 children with acquired primary hypothyroidism due to Hashimoto's thyroiditis (HT) presenting with unusual manifestations. We described 3 children with acquired primary hypothyroidism due to HT. One of our patients had musculoskeletal pain and was diagnosed and treated as having connective tissue disease. Another patient presented with chest pain, dyspnea, and swelling in the abdomen. She had a massive pericardial effusion (PE). Two patients had severe growth failure. A third patient with Down syndrome had a small PE. Her complaint was dyspnea during sleep. All patients improved with thyroxin therapy. Patients with hypothyroidism due to HT who have complicated clinical manifestations were misdiagnosed and mismanaged at childhood and adolescence. Growth failure is an important sign in children and adolescents. In the presence of complicated manifestations in children and adolescents, thyroid dysfunction must be considered in differential diagnosis.
复杂的临床表现以及特定症状出现的时间各异，可能会导致诊断困难，尤其是在儿童和青少年中。本文介绍了3例因桥本甲状腺炎（HT）导致获得性原发性甲状腺功能减退症的儿童患者，他们表现出不寻常的症状，在诊断过程中遇到了困难并存在误诊情况。我们描述了3例因HT导致获得性原发性甲状腺功能减退症的儿童患者。其中1例患者有肌肉骨骼疼痛，最初被诊断并当作结缔组织病进行治疗。另1例患者表现为胸痛、呼吸困难和腹部肿胀，她有大量心包积液（PE）。2例患者有严重生长发育迟缓。第3例患有唐氏综合征的患者有少量PE，她的症状是睡眠期间呼吸困难。所有患者经甲状腺素治疗后病情均有改善。因HT导致甲状腺功能减退症且有复杂临床表现的患者，在儿童期和青少年期被误诊和错误治疗。生长发育迟缓是儿童和青少年的一个重要体征。在儿童和青少年出现复杂表现时，鉴别诊断中必须考虑甲状腺功能障碍。
