소아청소년기의 갑상샘중독증을 동반한 자가면역성 갑상샘염의 특징
Thyrotoxicosis Associated with Autoimmune Thyroiditis in Children and Adolescents
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목적: 소아청소년기의 갑상샘중독증이 동반된 자가면역성 갑상샘염(TAIT)의 빈도를 추정하고 임상적 특징을 알아보고자 하였다. 방법: 갑상샘에 대한 자가면역성이 확인된 18세 이하의 220명을 대상으로 하여, 전체 대상을 TAIT, 정상갑상샘기능또는 갑상샘저하가 동반된 자가면역성 갑상샘염(AIT), 그레이브스병 및 미분류형으로 구분하였다. 후향적 의무기록조사를 통해 대상에 대한 임상적 정보를 조사하였고, TAIT인 대상에서 추적관찰 중 갑상샘 기능의 변화를 조사하였다. 결과: 총 220명의 대상 중 147명이 AIT로, 47명은 그레이브스병으로 진단되었다. AIT로 진단된 147명 중 14명(9.5%)이 TAIT로 진단되었고, 진단 시 갑상샘중독증이 있었던 65명 중 8명(12.3%)이 TAIT로 판명되었다. TAIT 상태에서의증상은 그레이브스병의 증상과 유사하였으나, Technetium-99m 스캔을 한 경우 동위원소의 섭취율은 감소되어 있었다. 갑상샘중독증의 발견 후 2-6주간 지속되었으며, 14명의 TAIT 중 6명에서 반복적인 갑상샘중독증이 관찰되었고,진단 시 갑상샘중독증이 있었던 8명 중 4명에서 추적 관찰 중 불현성 또는 현성 갑상샘저하증이 발생하였다. 결론: 소아청소년기의 TAIT는 드물지 않아 갑상샘중독증이 있으면 이의 가능성을 고려해야 하여, 갑상샘중독증의 완해 후 반복적 갑상샘중독증 및 갑상샘저하증 등 다양한 기능의 변화가 있어 갑상샘중독증이 해소된 후에도 주의 깊은추적 관찰이 필요하다.
Abstract
Purpose: The aims of this study are to estimate the frequency of thyrotoxicosis associated with autoimmune thyroiditis (TAIT) and to investigate the characteristics of TAIT in children and adolescents. Methods: 220 subjects who had shown thyroid autoimmunity before the age of 18were included. All the subjects were divided as autoimmune thyroiditis (AIT), Graves’disease and unspecified group. In addition, AIT was subdivided as TAIT and euthyroid or hypothyroid AIT. Clinical data were review and the variation of thyroid hormone status was investigated among the subjects with TAIT. Results: Of 220 subjects who showed thyroid autoimmunity, 147 subjects were diagnosed as AIT and 47 were as Graves' disease. Among 147 subjects with AIT, 14subjects (9.5%) had presented TAIT. Among 65 subjects who had initially presented with thyrotoxicosis, 8 subjects (12.3%) were compatible with TAIT. Whereas presenting symptoms of TAIT were similar to those of Graves’ disease, Technetium-99m scan had showed thyroid with decreased uptake. The durations of thyrotoxicosis were several weeks. 6 of 14 TAIT subjects showed recurrent thyrotoxicosis, and 4 of 8 patients who had initially presented with thyrotoxicosis showed subclinical or overt hypothyroidism during follow-up. Conclusions: Possibility of TAIT should not be overlooked when a patient presents thyrotoxicosis, because this condition is not so rare in children and adolescents. Long term follow-up after resolution of thyrotoxicosis is necessary because of a diverse clinical course.
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