그레이브스병과 동반되어 발생한 연소성 악성빈혈의 치료 1례
The Treatment of Pernicious Anemia in Children with Graves' Disease
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갑상선 질환을 비롯한 자가면역성 질환은 다인성 및 유전적 경향을 띠고 있으며 HLA-DR과 관련이 있다고 알려져 있다. 다른 자가면역성 질환을 동반하는 경우가 흔하며 1형 당뇨, 류마티스 관절염 , 전신성홍반성루푸스, 쇼그렌증후군,염증성 장질환, 중증근무력증이나 악성빈혈, 백반증, 셀리악병, 자가면역성 간염 및 원형탈모증과 동반되는 경우가 보고되어 있다. 5년 전 그레이브스병 진단 후 메티마졸을 복용하였으나 순응도가 높지 않아 치료가 부진하였던 16세 환자에서 악성빈혈이 동반되어 발생하였다. 환자는 비타민 B_(12) 근육주사와 메티마졸 병행치료 후 악성빈혈 소견 호전되었고 정상적인 갑상선 기능을 보였다. 현재 환자는 비타민 B_(12) 치료를 중단한 후 메티마졸 치료로 외래에서 경과 관찰중이다. 저자들은 그레이브스병과 동반되어 발생한 연소성 악성빈혈에서 기저 질환 조절 후 약물 치료가 필요 없게 된환자 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Abstract
Organ specific autoimmune diseases may occur in the same individual. Type III polyglandular autoimmune disease is defined by the occurrence in the same individual of two or more of the following: autoimmune thyroid disease, pernicious anemia,insulin dependent diabetes, and other organ specific autoimmune diseases not falling into class I or class II categories. A 16-year-old girl developed pernicious anemia during the treatment of Graves'disease. She was diagnosed with Graves' disease 5 years ago and had received methimazole 20 mg/day, but the medication was not well tolerated. Bone marrow findings were compatible with pernicious anemia as macrocytic normochromic red blood cell (RBC) and increased megakaryocyte. The serum value of vitamin B12 was low, and the serum titer of antibody to gastric parietal cell was high. After diagnosis of pernicious anemia, she had treatment by monthly intramuscular vitamin B12 and methimazole (20 mg/day). The values of hemoglobin and RBC indices as well as thyroid function were normalized after 2 months. Vitamin B12 therapy was maintained for 1 year with normal RBC indices. At present, she dose not receive treatment with vitamin B12but she does receive methimazole treatment. We report a case of treatment of pernicious anemia in a 16 year-old girl during treatment for Graves disease.
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