소아 청소년 그레이브스병의 약물치료에 대한 임상 경과 및 예후에 영향을 미치는 인자
The Clinical Course and Prognostic Factors to Medical Treatment of Graves' Disease in Children and Adolescents
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 소아청소년의 그레이브스병을 항갑상샘제로 치료를 하는 동안에 관해율을 비롯한 임상경과의 관찰과 관해에 관련되는 인자들을 평가해 보고자 하였다. 방법: 1994년 1월부터 2009년 12월까지 충북대학교병원 소아내분비 클리닉에서 그레이브스병으로 진단받고 항갑상샘제로 치료받으며 최소 2년 이상 추적관찰이 된 18세 미만의 환아 42명(남아 8명)을 후향적으로 연구하였다. 이들의연령은 진단 시 평균 11.5±3.4세였고 평균 추적관찰기간은 4.5±2.2년이었다. 결과: 진단 시 대상 환아 중 64.3%가 사춘기에 있었고, 87.8%가 갑상샘종을 보였고 38.9%는 안구돌출증을 보였다. 여아에서 갑상샘종이 의미있게 많았다(P <0.05). TRAb는 전 환자에서 다 양성이었고, AMA는 88.1%, ATA는 81.0%에서 양성이었다. 22명(52.4%)에서 평균 4.3±2.5년의 투약 기간으로 관해에 도달하였으며, 나머지 20명은 마지막 추적관찰 시기인 평균 4.8±1.8년에도 계속 투약 중이었다. 관해에 걸리는 시간을 4분위수로 추정해보면, 25백분위수가평균 3.7년, 50백분위수가 평균 7.1년, 그리고 75백분위수가 평균 9.2년이었다. 진단 시 높은 TSH치 만이 관해와 의미 있는 관련성을 보였다(P <0.01). 결론: 그레이브스병을 가진 소아 청소년에서 항갑상샘제만으로 치료 시, 관해유도에 필요한 시간이 너무 길어 성인에서처럼 고정된 치료기간을 확립하여 결정적 치료방법을 선택할 수 있는 다기관 공동 연구가 필요하겠다.
Abstract
Purpose: The aim of this study was to observe clinical course including remission rate during antithyroid medication for Graves’ disease in children and adolescents, and to evaluate factors related to remission. Methods: This is a retrospective study of 42 patients (8 males), who were diagnosed at pediatric endocrine clinic in Chungbuk National University Hospital from January 1994 to December 2009. They were treated with antithyroid drugs only and were followed for at least 2 years. Their average age at diagnosis was 11.5 ± 3.4 years, and average follow-up period was 4.5 ± 2.2 years. Results: At diagnosis, 64.3% of the subjects were in puberty, 87.8% showed goiter which was significantly prevalent in females (P < 0.05), and 38.9% manifested exophthalmos. Thyrotropin receptor antibody was positive in all the patients, whereas anti-microsomal antibody was positive in 88.1% and anti-thyroglobulin antibody in 81.0%. Twenty two (52.4%)patients remitted with 4.3 ± 2.5 years' medication, and the others were continuously medicated at the last follow-up of 4.8 ± 1.8 years. By quartile estimate for the remission time, 25 percentile was remitted at 3.7 years, 50 percentile at 7.1 years, and 75 percentile at 9.2 years. Among the factors for the remission, initial thyroid stimulating hormone level was significantly lower in non-remission group compared to remission group (P < 0.05). Conclusion: In pediatric Graves' disease treated only antithyroid drugs, the time required for remission is so long that it is necessary to establish fixed medication period and to choose definitive treatment modality as in adult Graves' disease through multicenter clinical study.
참고문헌 (23)
- Kaguelidou F, "Graves' disease in childhood: advances in management with antithyroid drug therapy", Horm Res, 71, pp.310~317 (2009)
- Bauer AJ, "Approach to the pediatric patient with Graves' disease: when is definitive therapy warranted?", J Clin Endocrinol Metab, 96, pp.580~588 (2011)
- WHO, "Indicators for assessing iodine deficiency disorders and their control through salt iodization", pp.World Health Organization, UNICEF
- Perez C, "Technique of endemic goitre surveys, In Endemic goitre. Monograph series no. 44", pp.369~383 (1960), World Health Organization
- Lippe BM, "Hyperthyroidism in children treated with long term medical therapy: twentyfive percent remission every two years", J Clin Endocrinol Metab, 64, pp.1241~1245 (1987)
- Gruñeiro-Papendieck L, "Pediatric Graves' disease: outcome and treatment", J Pediatr Endocrinol Metab, 16, pp.1249~1255 (2003)
- Maugendre D, "Antithyroid drugs and Graves' disease-prospective randomized assessment of long-term treatment", Clin Endocrinol (Oxf), 50, pp.127~132 (1999)
- Romaldini JH, "Comparison of effects of high and low dosage regimens of antithyroid drugs in the management of Graves' hyperthyroidism", J Clin Endocrinol Metab, 57, pp.563~570 (1983)
- Jorde R, "Short-term treatment of Graves' disease with methimazole in high versus low doses", J Intern Med, 238, pp.161~165 (1995)
- Hashizume K, "Administration of thyroxine in treated Graves' disease. Effects on the level of antibodies to thyroidstimulating hormone receptors and on the risk of recurrence of hyperthyroidism", N Engl J Med, 324, pp.947~953 (1991)
- Reinwein D, "A prospective randomized trial of antithyroid drug dose in Graves' disease therapy. European Multicenter Study Group on Antithyroid Drug Treatment", J Clin Endocrinol Metab, 76, pp.1516~1521 (1993)
- Lucas A, "Medical therapy of Graves' disease: does thyroxine prevent recurrence of hyperthyroidism?", J Clin Endocrinol Metab, 82, pp.2410~2413 (1997)
- Leech NJ, "Controversies in the management of Graves' disease", Clin Endocrinol (Oxf), 49, pp.273~280 (1998)
- Rivkees SA, "An optimal treatment for pediatric Graves' disease is radioiodine", J Clin Endocrinol Metab, 92, pp.797~800 (2007)
- Lee JA, "The optimal treatment for pediatric Graves' disease is surgery", J Clin Endocrinol Metab, 92, pp.801~803 (2007)
- Hamburger JI, "Management of hyperthyroidism in children and adolescents", J Clin Endocrinol Metab, 60, pp.1019~1024 (1985)
- Rivkees SA, "63 years and 715 days to the "boxed warning": unmasking of the propylthiouracil problem", Int J Pediatr Endocrinol (2010)
- Glaser NS, "Organization of Pediatric Endocrinologists of Northern California Collaborative Graves' Disease Study Group. Predicting the likelihood of remission in children with Graves' disease: a prospective, multicenter study", Pediatrics, 121, pp.e481~e488 (2008)
- Shulman DI, "Autoimmune hyperthyroidism in prepubertal children and adolescents: comparison of clinical and biochemical features at diagnosis and responses to medical therapy", Thyroid, 7, pp.755~760 (1997)
- 송승민, "한국 소아 및 청소년 Graves병의 자연 경과 및 예후 인자", Korean Journal of Pediatrics, 53(4), pp.585~591 (2010), 대한소아과학회
- Feldt Feldt-Rasmussen U, "Metaanalysis evaluation of the impact of thyrotropin receptor antibodies on long term remission after medical therapy of Graves' disease", J Clin Endocrinol Metab, 78, pp.98~102 (1994)
- 이선희, "소아 및 청소년 그레이브스병 환자에서의 관해 예측 인자와 관해율", Korean Journal of Pediatrics, 52(9), pp.1021~1028 (2009), 대한소아과학회
- Schott M, "Levels of autoantibodies against human TSH receptor predict relapse of hyperthyroidism in Graves' disease", Horm Metab Res, 36, pp.92~96 (2004)