Uncommon symptoms e. g. hands myxedema and pain in small joints of hands in hypothyroidism pa -tients might be misdiagnosed as rheumatoid arthritis . We have treated a 70-year-old female patient, who complained of diffuse swelling of the hands 10 years before admission and severe pain in multiple proximal , distal inter -phalangeal joints and the radial side of left wrist for 1 year. X-ray showed cystic erosion in the articular surface and edge, marginal sclerosis, narrowed joint space in the related joints. Laboratory findings showed rheumatoid factor and anti-cyclic citrullinated peptide antiboy negative , Free three iodine thyeonine ( FT3 ) normal, free thyroxine ( FT4) declined and thyroid stimulating hormone ( TSH) rised. She underwent thyroid isotope therapy 30 years ago and the latest thyroid hormone level suggested hypothyroidism . She was diagnosed secondary hypothyroidism and hand erosive osteoarthritis. After treated with thyroxine , glucosamine hydrochloride and meloxicam , her symptoms were remarkably improved. Several case reports revealed secondary hypothyroidism combined with erosion os -teoarthritis. However their relationships require further research.%少部分甲状腺功能减退症(甲减)患者发生双手黏液性水肿伴手小关节痛,易误诊为类风湿关节炎.笔者曾收治1例70岁女性患者,入院前10年出现双手弥漫性肿胀,近1年出现双手多个近端、远端指间关节及左手腕桡侧痛.X线摄片检查示上述关节面及关节边缘骨质囊状侵蚀,边缘硬化,关节间隙变窄,RF及抗环瓜氨酸肽抗体均阴性.患者30年前曾行甲状腺同位素治疗,查甲状腺激素水平提示甲减.诊断考虑继发性甲减合并手侵蚀性骨关节炎.予左甲状腺素、盐酸氨基葡萄糖及美洛昔康等治疗后全身症状及关节肿痛明显好转.国外亦有继发性甲减合并侵蚀性骨关节炎的个案报道,但侵蚀性骨关节炎是否继发于甲减值得进一步关注.
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