1개월 이상 집중치료를 받은 신생아에서 발견되는 갑상샘 기능의 이상
Thyroid Dysfunction Detected in Intensively Cared Neonates for More than 1 Month
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목 적:신생아집중치료실에서 치료를 받는 신생아인 경우에 갑상샘기능이상의 빈도가 높다. 이에 집중치료를 받은 신생아에서 갑상샘기능이상의 빈도, 발견시기, 기능이상의 종류와 위험 인자들에 관하여 알아보고자 하였다. 방 법:2006년 7월부터 2009년 6월까지 3년 동안 충북대학교병원 신생아집중치료실에서 1개월 이상 집중치료를 받았고, 생후 2주 이내에 조기 선별검사 및 2주 이후에 추적검사를 포함하여 2번 이상의 갑상샘기능검사를 받았던 67명의 신생아의 의무기록을 통하여 후향적 연구를 하였다. 결 과: 1) 추적검사에서 발견된 42명의 갑상샘기능이상군(62.7% VLBW 30명 포함) 중에서 단지 9명(VLBW 8명 포함)에서만 조기선별검사에서 갑상샘기능이상을 보였다. 조기선별검사에서 정상으로 나온 57명 중에서, 추적검사에서 이상을 보인 경우가 33명(57.9%, VLBW 22명 포함)이 있었다. 추적검사에서 갑상샘기능이상은 2-4주에 15명, 4-6주에 15명, 6-8주에 3명에서 발견되었다. 2) 추적검사의 갑상샘기능이상의 종류는 현저한 TSH의 증가를 동반한 일차성갑상샘기능저하(n=7), 경한 일차성 갑상샘기능저하(n=3), 고갑상샘자극호르몬혈증(n=11), 저티록신혈증(n=7), 그리고 비갑상샘질환(n= 14)이 있었다. 3) 정상 갑상샘기능군에 비하여 기능이상군에서 출생체중이 더 작았고, 재태기간이 더 짧았으며, 신생아호흡곤란증후군의 이환이 의미있게 많았다(P˂0.05). 4) 비갑상샘질환을 제외한 갑상샘기능이상 환아의 일부(n=15, 35.7%)가 갑상샘호르몬을 투여 받았다. 결 론: 집중치료를 받는 신생아 특히 VLBW에서 갑상샘기능이상의 발생이 매우 높았으며, 상당수는 조기선별검사에서 발견되지 않고 생후 2주 이후 늦게 발견되는 수가 많으므로 이들에서 적어도 생후 2주에서 8주까지 추적 갑상샘기능검사를 시행해야하며, 이들의 갑상샘 기능이상의 종류와 특성, 장기적인 예후에 대한 연구를 통하여 적절한 치료지침을 마련하는 것이 중요하다고 하겠다.
Abstract
Purpose:To evaluate the incidence, time of detection, classification, and risk factors of thyroid dysfunction in neonates at a neonatal intensive care unit. Methods:This is a retrospective study reviewing medical records of 67 infants (including 40 very low birth weight infants, VLBW), who were admitted for more than 1 month at Chungbuk National University Hospital from July 2006 to June 2009. Initial screening and repeat thyroid function tests were performed before and after two weeks of age. Results:1) In the thyroid dysfunctional group (42/67, 62.7% including 30 VLBW), only 9 infants (including 8 VLBW) were abnormal at screening. Among 57 infants with normal screening, 33 infants (57.9%, including 22 VLBW) changed to abnormal at follow-up. The detection times at the repeat test were 2-4 weeks of age (WA) (n=15), 4-6 WA (n=15), and 6-8 WA (n=3). 2) The types of dysfunction were primary hypothyroidism (PH) with marked TSH rise (n=7), mild PH (n=3), hyperthyrotropinemia (n=11), hypothyroxinemia (n=7), and non-thyroidal illness (n=14). 3) Compared to the normal group (n=25), the dysfunctional group (n=42) had lower birth weight, shorter gestational age, and more morbidity of respiratory distress syndrome (P ˂0.05). 4) Thyroxine was prescribed in 15cases (35.7%) in the dysfunctional group except non-thyroidal illness. Conclusion:Thyroid dysfunction was common in the intensively cared neonates, especially in VLBW, and many cases were detected at the repeat test. The thyroid function test should therefore be repeated at least from 2 WA to 8 WA, and a proper management plan established by investigate the characteristics and long-term prognosis of these neonates.
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