소아 갑상선 안병증의 임상적 특징
The Clinical Characteristics of Thyroid Orbitopathy in Thyroid Dysfunction Pediatric Patients
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목적: 소아 갑상선 환자를 대상으로 소아 갑상선 안병증의 임상특징과 치료에 대하여 알아보고자 하였다. 대상과 방법: 2010년 9월부터 2012년 9월까지 본원 소아과에서 자가면역성 갑상선 질환을 진단받고, 갑상선 안병증 진료를 위해 내원한환자 34명을 대상으로 소아 갑상선 안병증의 발생률과 임상적 특성에 대하여 의무기록을 후향적으로 분석하였다. 결과: 추적관찰 기간 24.1개월 동안 그레이브씨 병 환자가 14명(41.2%), 하시모토 갑상선염 환자가 20명(58.8%)이었고, 34명 중 15명(44.1%)에서 안증상이 발생하였다. 눈꺼풀 부종 14명(41.2%), 눈꺼풀 후퇴 8명(23.5%), 눈꺼풀내림지체 6명(17.6%) 등 눈꺼풀 증상이가장 많았다. 결막 충혈 5명(14.7%), 안구돌출 3명(8.8%), CT상 외안근 비대 6명(17.6%)이었으며, 그 외 시력저하, 시야결손, 외안근운동장애 등의 심한 안증상은 없었다. 3명(8.8%)에서 눈꺼풀 후퇴 교정술이 필요하였으나, 대부분은 보존적 치료만으로 유지되었다. 결론: 소아 갑상선 안병증은 그레이브씨 병과 하시모토 갑상선염에서 모두 빈번하게 관찰되었고, 성인에 비해 임상양상의 발현과 경과가 경미하여 보존적 치료로 유지되는 특징을 가진다.
Abstract
Purpose: To investigate the clinical characteristics and treatment methods for pediatric thyroid-associated orbitopathy in pediatric patients with thyroid disorders. Methods: To determine the prevalence and clinical characteristics of pediatric thyroid-associated orbitopathy, we retrospectively analyzed the medical records of 34 patients admitted to the Pediatrics Department of our institution between September 2010 and September 2012. The patients had been diagnosed with autoimmune thyroid disorder and were admitted for treatment of thyroid-associated orbitopathy. Results: In the 24.1 months of follow-up observation, 14 patients were diagnosed with Graves’ disease (41.2%) and 20 patients with Hashimoto’s thyroiditis (58.8%). Of the 34 patients, 15 (44.1%) developed eye symptoms. Among the eye symptoms, lid swelling was the most prevalent in 41.2% of patients, followed by eyelid retraction in 23.5%, lid lag in 17.6%,conjunctival injection in 14.7%, proptosis in 8.8%, and extraocular muscle hypertrophy in 17.6%. Severe impairment of visual acuity, visual field, and ocular motility were not observed in our study. Although eyelid surgery was performed in 3 cases,most patients were treated conservatively. Conclusions: Pediatric thyroid-associated orbitopathy was frequently observed in patients with Graves’ disease and Hashimoto’s thyroiditis. Compared to adults, children showed milder disease manifestation and progression, and the disease could be managed with conservative treatment.
참고문헌 (35)
- El-Kaissi S, "Thyroid-associated ophthalmopathy: a practical guide to classification, natural history and management", Intern Med J, 34, pp.482~491 (2004)
- Barker DJ, "Current incidence of thyrotoxicosis and past prevalence of goitre in 12 British towns", Lancet, 2, pp.567~570 (1984)
- Perrild H, "Clinical aspects and treatment of juvenile Graves’ disease", Exp Clin Endocrinol Diabetes, 105(Suppl 4), pp.55~57 (1997)
- Kraiem Z, "Newfield RS. Graves' disease in childhood", J Pediatr Endocrinol Metab, 14, pp.229~243 (2001)
- Krassas GE, "Childhood Graves' ophthalmopathy: results of a European questionaire study", Eur J Endocrinol, 153, pp.515~521 (2005)
- Eha J, "Clinical features of pediatric Graves' orbitopathy", Int Ophthalmol, 30, pp.717~721 (2010)
- Chan W, "Ophthalmopathy in childhood Graves’ disease", Br J Ophthalmol, 86, pp.740~742 (2002)
- Wong GW, "Increasing incidence of childhood Graves’ disease in Hong Kong: a follow-up study", Clin Endocrin (Oxf), 54, pp.547~550 (2001)
- Mourits MP, "Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy", Clin Endocrinol (Oxf), 47, pp.9~14 (1997)
- Werner SC, "Classification of the eye changes of Graves’ disease", J Clin Endocrinol Metab, 29, pp.982~984 (1969)
- Wiersinga WM, "Classification of eye changes of Graves' disease", Thyroid, 1, pp.357~360 (1991)
- Kendler DL, "The initial characteristics of Graves’ orbitopathy vary with age and sex", Arch Ophthalmol, 111, pp.197~201 (1993)
- Perros P, "Age and gender influence the severity of thyroid-associated ophthalmopathy: a study of 101 patients attending a combined thyroid eye clinic", Clin Endocrinol (Oxf), 38, pp.367~372 (1993)
- Bartley GB, "The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota", Trans Am Ophthalmol Soc, 92, pp.477~588 (1994)
- Bartley GB, "Clinical features of Graves’ ophthalmopathy in an incidence cohort", Am J Ophthalmol, 121, pp.284~290 (1996)
- Rhee K, "The clinical study on Graves’ ophthlamopathy", J Korean Ophthlamol Soc, 40, pp.2923~2927 (1999)
- Rhim WI, "Correlation between the thyroid associated ophthalmopathy and thyroid function state", J Korean Ophthlamol Soc, 43, pp.431~436 (2002)
- Young LA, "Dysthyroid ophthalmopathy in children", J Pediatr Ophthalmol Strabismus, 16, pp.105~107 (1979)
- Liu GT, "Prominent proptosis in childhood thyroid eye disease.", Ophthalmology, 103, pp.779~784 (1996)
- Goldstein SM, "Pediatric thyroid-associated orbitopathy: The children's hospital of philadelphia experience and literature review", Thyroid, 18, pp.997~999 (2008)
- Nucci P, "Normal exophthalmometric values in children", Am J Ophthalmol, 108, pp.582~584 (1989)
- Dijkstal JM, "Normal exophthalmometry measurements in a United States pediatric population", Ophthal Plast Reconstr Surg, 28, pp.54~56 (2012)
- 김중훈, "갑상선 안병증에서 병의 경과에 영향을 미치는 요인들에 관한 연구", 대한안과학회지, 52(3), pp.255~260 (2011), 대한안과학회
- Uretsky SH, "Graves’ ophthalmopathy in childhood and adolescence", Arch Ophthalmol, 98, pp.1963~1964 (1980)
- Young LA, "Dysthyroid ophthalmopathy in children", J Pediatr Ophthalmol Strabismus, 16, pp.105~107 (1979)
- Grüters A, "Ocular manifestations in children and adolescents with thyrotoxicosis", Exp Clin Endocrinol Diabetes, 107(Suppl 5), pp.S172~S174 (1999)
- Shine B, "Association between Graves’ ophthalmopathy and smoking", Lancet, 335, pp.1261~1263 (1990)
- Hegediüs L, "Relationship between cigarette smoking and Graves‘ ophthalmopathy", J Endocrinol Invest, 27, pp.265~271 (2004)
- Holm IA, "Smoking and other lifestyle factors and the risk of Graves‘ hyperthyroidism", Arch Intern Med, 165, pp.1606~1611 (2005)
- Hägg E, "Is endocrine ophthalmopathy related to smoking?", Br Med J, 295, pp.634~635 (1987)
- Krassas GE, "Smoking and autoimmune thyroid disease: the plot thickens", Eur J Endocrinol, 154, pp.777~780 (2006)
- Pfeilschifter J, "Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs. lifetime cigarette consumption", Clin Endocrinol (Oxf), 45, pp.477~481 (1996)
- Bergman P, "Review of the outcome of management of Graves’ disease in children and adolescents", J Paediatr Child Health, 37, pp.176~182 (2001)
- Durairaj VD, "Clinical features and treatment of Graves’ ophthalmopathy in pediatric patients", Ophthal Plast Reconstr Surg, 22, pp.7~12 (2006)
- Holt H, , J AAPOS, 12, pp.357~360 (2008)