정상갑상샘기능 갑상샘눈병증 환자의 임상적 특징
Clinical Characteristics of Patients with Euthyroid Thyroid-associated Ophthalmopathy
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목적: 정상갑상샘기능 갑상샘눈병증 환자의 임상적인 특징을 갑상샘기능항진 환자와 비교하여 보고자 한다. 대상과 방법: 2015년 9월부터 2021년 1월까지 양산부산대학교병원에서 갑상샘눈병증을 진단받은 환자 중 갑상샘기능이 정상인 16명과 갑상샘항진증을 진단받은 80명, 총 96명을 대상으로 연령, 성별, 흡연 여부, 고혈압과 당뇨 병력, 경과 관찰 기간, 한 눈 침범 여부, 눈꺼풀 및 결막 소견, 눈꺼풀후퇴 및 내림지연 여부, 임상활동도 점수, modified NOSPECS 점수, 안구돌출도, Hess검사, 외안근 단면적, 스테로이드와 방사선 치료 여부, 혈중 유리 티록신, 갑상샘자극호르몬, 항티로글로불린항체, 항갑상샘과산화효소항체, 갑상샘자극호르몬수용체항체, 갑상샘자극 면역글로불린 농도를 조사하였다. 결과: 갑상샘항진군에 비해 정상갑상샘기능군의 한 눈 침범의 비율이 유의하게 높았으며, 결막충혈, 임상활동도 점수, modified NOSPECS의 연조직 점수, Hess검사 안구운동 제한, 하직근 최대 단면적, 정맥내 고용량 스테로이드 치료 여부, 혈중 유리 티록신, 항티로글로불린항체, 항갑상샘과산화효소항체, 갑상샘자극호르몬수용체항체 농도는 정상갑상샘기능군에서 유의하게 낮았다. 결론: 정상갑상샘기능 갑상샘눈병증 환자는 갑상샘기능항진군에 비해 한 눈을 잘 침범하고 임상활동도와 중증도가 낮았으며, 하직근비대와 안구운동 제한 및 고용량 스테로이드 치료 시행 비율이 적었다. 또한 혈중 유리 티록신, 항티로글로불린항체, 항갑상샘과산화효소항체, 갑상샘자극호르몬수용체항체의 농도가 더 낮은 특징이 있다.
Abstract
Purpose: To compare clinical features between thyroid-associated ophthalmopathy (TAO) patients with hyperthyroidism and euthyroidism. Methods: Between September 2015 and January 2021, we enrolled 96 TAO patients with euthyroidism (n = 16) or hyperthyroidism (n = 80). We recorded the age, sex, smoking status, presence of hypertension and diabetes, total follow-up period, unilateral involvement, eyelid edema, lid lag and retraction, clinical activity score (CAS), modified NOSPECS score, exophthalmometry, Hess test, area of extraocular muscles on orbital computed tomography (CT), treatment with systemic and subconjunctival steroids and radiotherapy, and serum levels of free thyroxine, thyroid-stimulating hormone (TSH), anti-thyroglobulin antibody (anti-Tg Ab), anti-thyroid peroxidase antibody (anti-TPO Ab), TSH receptor antibody (TSHR Ab), and thyroid stimulating antibody. Results: Unilateral involvement was significantly more common in the euthyroid group, while conjunctival injection, CAS, extraocular muscle movement restriction within 10° on the Hess chart, maximum cross-sectional area of the inferior rectus on orbital CT, and treatment with intravenous high-dose steroid were significantly more common in the hyperthyroid group. Furthermore, the modified NOSPECS score and levels of free thyroxine, anti-Tg Ab, anti-TPO Ab, and TSHR Ab were significantly higher in the hyperthyroid than euthyroid group. Conclusions: Compared to hyperthyroid TAO patients, those with euthyroid TAO were more likely to have unilateral involvement. They also had lower clinical activity and severity, milder enlargement of extraocular muscles (EOMs), and lower rates of EOM movement restriction and treatment with intravenous high-dose steroid. Euthyroid TAO patients had lower levels of free thyroxine, anti-Tg Ab, anti-TPO Ab, and TSHR Ab compared to hyperthyroid TAO patients.
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