原發性甲狀腺功能低下症：一個誤診為原發性高血脂症的病例報告

Primary Hypothyroidism: A Misdiagnosis as "Primary Hyperlipidemia

謝政男(Cheng-Nan Hsieh)

《安泰醫護雜誌》 15卷2期 (2009/06) Pp. 125-134

https://doi.org/10.7078/TSMHMNJN.200906.0125

摘要

甲狀腺功能低下症是僅次於糖尿病之外，造成續發性高血脂症最常見的原因。若不糾正甲狀腺功能低下的情形，而一昧以降血脂的藥物治療，那不但增加醫療成本，且更可能錯失了恢復病人甲狀腺功能的機會。本篇就一位原先診斷為原發性高血脂症的病人，經過降血脂藥物的治療及生活型態的改變，雖然成功的降低高血脂的情形，但是病人易倦怠、疲憊的情形卻始終持續。後來為病人測量血中的甲狀腺素，才發現是甲狀腺低下症。而頸部超音波也顯示病人兩側甲狀腺均呈現萎縮。由病人的血液中抗微小體抗體陽性及甲狀腺超音波的影像，診斷為自體免疫性甲狀腺炎所致的原發性甲狀腺功能低下。病患經由甲狀腺素的補充，血中總膽固醇的數值回復到正常，且容易疲憊的情況也沒有再發生。本文的目的是希望藉此病歷及文獻的回顧，提醒臨床醫師，在初次面對高血脂症的病人，一定要仔細的排除續發性病因的存在，早期發現，早期治療，才能減少併發症的發生。

關鍵字

續發性高血脂症 ； 原發性甲狀腺低下症 ； 自體免疫性甲狀腺炎

並列摘要

Hypothyroidism is the most common cause of secondary hyperlipidemia other than diabetes mellitus. The use of antihyperlipidemic drugs without correction of hypothyroidism not only increases the cost of medical care, but also delay the restoration of thyroid function. This case report presents a patient who was originally diagnosed as primary hyperlipidemia. Hyperlipidemia of this patient was improved after treating with antihyperlipidemic drugs and life modification. However, this patient still complained of easy tiredness. After further study, thyroid function test showed hypothyroidism. Ultrasonography of neck revealed bilateral thyroid gland atrophy. Primary hypothyroidism caused by autoimmune thyroiditis was diagnosed according to imaging study and antimicrosomal antibody positive in blood. After thyroxine supplement, his cholesterol level in blood returned to normal and there was no recurrence of easy tiredness. In reviewing the clinical presentation, imaging study and laboratory examination, we want to remind clinical physicians to exclude carefully the possibility of secondary hyperlipidemia when hyperlipidemia was just noted. With early diagnosis and treatment, complications and morbidity can be reduced.

並列關鍵字

secondary hyperlipidemia ； primary hypothyroidism ； autoimmune thyroiditis