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心包炎症状为主诉的甲减一例山西省人民医院（０３００１２）康淑贞太原市公交公司门诊部张思格患者。男，１４岁。因颜面及两下肢浮肿，乏力，活动后心慌，胸闷，气短半个月，伴记忆力差，无畏寒，于１９９２年３月１６日就诊。查体：颜面苍黄浮肿，甲状腺不大，胸对称，两肺呼吸音粗，心界叩诊增大，心脏各瓣膜未闻杂音，心音低钝，心律齐，心率４１次／分，腹软、肝脾肋下未触及，两下肢非可凹性浮肿。化验检查：Ｈｂ１０．５ｇ／Ｌ，ＢＵＮ５．０ｍｍｏｌ／Ｌ，肝功能检查ＴＴＴ７ｕ，ＴＦＴ（＋），ＴＰｒ７４ｇ／Ｌ，ＡＬＢ４５ｇ／Ｌ，ＥＳＲ２２ｍｍＨ２Ｏ／１小时末。血浆脂蛋白检查：Ｔ－ｃｈ０６．５１ｍｍｏｌ／Ｌ，ＨＤＬ－Ｃ１．８ｍｍｏｌ／Ｌ，ＬＤＬ－Ｃ４．５ｍｍｏｌ／Ｌ，ＴＲ／Ｇ０．７ｍｍｏｌ／Ｌ，Ｂ－ＬＰ２．３ｇ／Ｌ。胸透：心脏呈烧瓶状。超声心动图：心包内可见液性暗区，示心包积液。心电图示：窦性心动过缓，心电轴不偏，ＴⅠ、Ⅱ、Ⅲ、Ｖ１－６低平，阿托品试验阳性，Ｔ３０．３９ｎｇ／ｍｌ，Ｔ４１．１４ｎｇ／ｄｌ，ＴＳＨ３４μＩｕ／ｍｌ。ＴＧＡ２％，ＴＭＡ３％。考虑为甲状腺减低，经放免测定血浆Ｔ３Ｔ４低于正常，ＴＳＨ明显增高，抗体滴定度不高，故诊断为
Pericarditis symptoms of a case of hypothyroidism Shanxi Provincial People’s Hospital (030012) Kang Shuzhen Taiyuan City Public Transport Company outpatient department patients with Ssang Si. Male, 14 years old. Due to facial and lower extremity edema, fatigue, palpitation after activities, chest tightness, shortness of breath for two weeks, with poor memory, no chills, March 16, 1992 treatment. Physical examination: facial pale yellow edema, thyroid is not large, chest symmetry, coarse breath sounds in both lungs, heart percussion increased, the heart of the valve unheard noise, heart sounds low blunt, heart rate Qi, heart rate 41 beats / Spleen ribs untouched, two lower limbs can be concave edema. Laboratory tests: Hb10.5g / L, BUN5.0mmol / L, liver function tests TTT7u, TFT (+), TPr74g / L, ALB45g / L, ESR22mmH2O / 1 hour end. Plasma lipoprotein test: T-ch06.51mmol / L, HDL-C1.8mmol / L, LDL-C4.5mmol / L, TR / G0.7mmol / L, B-LP2.3g / L. Chest throat: the heart was flask-shaped. Echocardiography: visible pericardial fluid dark area, showed pericardial effusion. ECG shows: sinus bradycardia, ECG axis is not partial, T Ⅰ, Ⅱ, Ⅲ, V1-6 low flat, positive atropine test, T30.39ng / ml, T41.14ng / dl, TSH34μIu / ml. TGA2%, TMA3%. Considered as hypothyroidism, by radioimmunoassay plasma T3T4 lower than normal, TSH was significantly increased, the antibody titer is not high, so the diagnosis is