病例:男,58岁。因多食、腹泻、消瘦、怕热、失眠、易激动、心悸1月入院。平素健康,有吸烟史30年,无咳嗽,咯血及胸痛。体检:T37.5,R20,P10。消瘦(1个月体重下降6kg),皮肤湿润,全身浅表淋巴结无肿大。双眼球无突出,辐辏运动减弱。双侧甲状腺Ⅰ度肿大,无结节,无触痛,血管杂音不明显。双肺呼吸音清晰。心率110次/分,律规整,心尖区闻及Ⅰ级收缩期杂音,肝脾未触及。Hb98g/L,WBC3.2×10~9/L,NO.68,LO.32,基础代谢率+52％。T_4240ng/ml(正常值42～135ng/ml),T_33.9ng/ml(正常值0.8～2.2ng/ml),TSH17μIu/ml(正常值0～10μIu/ml),肝功能正常。拟诊:弥漫性甲状腺肿伴甲状 Case: Male, 58 years old. Due to more food, diarrhea, weight loss, fearing heat, insomnia, irritability, palpitations January admission. Usually healthy, smoking history for 30 years, no cough, hemoptysis and chest pain. Physical examination: T37.5, R20, P10. Weight loss (1 month weight loss 6kg), the skin moist, systemic superficial lymph nodes without swelling. No prominent eyes, convergence of convergence movement weakened. Bilateral thyroid Ⅰ degree enlargement, no nodules, no tenderness, vascular murmur is not obvious. Breath sounds clear lungs. Heart rate 110 beats / min, law and regulation, apex area smell and Ⅰ systolic murmur, liver and spleen not touched. Hb98g / L, WBC3.2 × 10 ~ 9 / L, NO.68, LO.32, basal metabolic rate + 52%. T_4240ng / ml (normal value of 42 ~ 135ng / ml), T_33.9ng / ml (normal value of 0.8 ~ 2.2ng / ml), TSH17μIu / ml (normal value of 0 ~ 10μIu / ml), normal liver function. Proposed diagnosis: diffuse goiter with thyroid