探讨以肠系膜淋巴结炎为首发表现的Graves病临床特点及误诊原因。

回顾性分析2019年1月19日上海市第六人民医院东院内分泌代谢科收治的1例Graves病患者的临床资料，并进行文献复习。

患者男性，39岁，因腹痛、腹泻等症状就诊于普外科，实验室检查提示白细胞水平(1.88×10⁹/L)低，C-反应蛋白(3.37 mg/L)、降钙素原(0.08 μg/L)、白细胞介素-6(3.33 ng/L)等感染指标水平正常，大便常规及培养未见明显异常。上腹部CT提示肠系膜根部多发肿大淋巴结及结节灶，肠系膜脂膜炎可能，考虑肠系膜淋巴结炎。给予对症治疗后，腹痛、腹泻症状未见明显好转，入院后患者出现心悸、发热等症状，甲状腺功能：促甲状腺激素(TSH)<0.005 mU/L，游离三碘甲状腺原氨酸(FT3)32.13 pmol/L，游离甲状腺素(FT4)>100 pmol/L，抗甲状腺球蛋白抗体(TGAb)12.74 mU/L，甲状腺过氧化物酶抗体(TPOAb)320.70 mU/L，促甲状腺素受体抗体(TRAb)32.84 U/L。超声提示甲状腺弥漫性病变，考虑Graves病。

Graves病可累及多个系统，急性病患者就诊时应重视发病前情况，仔细深入地采集病史将有助于减少以不典型症状为主要表现的Graves病的误诊。

To explore the clinical features and misdiagnosis reasons of Graves disease in a patient with mesenteric lymphadenitis as the initial manifestation.

The clinical data of a patient with Graves disease admitted to the Department of Endocrinology and Metabolism, East Hospital of Shanghai Sixth People′s Hospital on January 19, 2019 were retrospectively analyzed, and the literatures were reviewed.

The patient who went to General Surgery Department was a 39-year-old male with clinical manifestations of abdominal pain and diarrhea. Laboratory examinations showed low levels of white blood cells (1.88×10⁹/L), normal infection indicators [C reactive protein (3.37 mg/L), procalcitonin (0.08 μg/L) and IL-6 (3.33 ng/L)], and no obvious abnormalities in stool routine and culture. CT of the upper abdomen showed that there were multiple enlarged lymph nodes and nodes focal at the root of the mesentery. Mesenteric panniculitis was possible and mesenteric lymphadenitis was considered. After symptomatic treatment, the symptoms of abdominal pain and diarrhea did not improved significantly, and symptoms such as palpitations and fever occurred after admission. At the same time, the thyroid function showed that thyroid stimulating hormone (TSH)<0.005 mU/L, free triiodothyronine (FT3) 32.13 pmol/L, free thyroxine (FT4)>100 pmol/L, antithyroglobulin antibody (TGAb) 12.74 mU/L, thyroid peroxidase antibody (TPOAb) 320.70 mU/L, thyrotropin receptor antibody (TRAb) 32.84 U/L. Ultrasound revealed diffuse thyroid lesion, and Graves disease was considered in the end.

Graves disease can involve multiple systems, the pre-onset of diseases should be taken seriously in patients with acute diseases. Careful and intensive collection of medical history will help reduce misdiagnosis of Graves disease with atypical symptoms as the main manifestation.