Graves 병과 혈청 면역글로불린-E의 연관성

김현영,박기룡,김성훈,김지연,송수근,최영식,박요한 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: Graves 병은 미만성 갑상선종, 갑상선기능한진, 안구침법 등을 특징으로 하는 자가면역성 질환으로, 갑상선자극호르몬 수용체에 대한 자가항체(TRAb)가 갑상선을 자극하여 발생된다. TRAb는 Graves병 환자의 약 85%이상에서 검출되며 활성화된 TRAb는 대부분 IgE로 알려져 있다. 그러나 최근 Graves병 환자의 갑상선조직과 안구조직에 IgE의 침착과 꽃가루 등에 의한 알레르기성 비염으로 인해 Graves병이 발생하거나 재발된 견우가 보고되어 Graves병의 병인에 IgE의 연관성이 제기 되고 있으나, 국내에서는 이에 대한 연구가 드물다. 본 연구에서는 Graves병에서의 혈청 IgE농도와 Graves병의 병기와의 관계 및 TRAb와 IgE 농도와의 연관성을 살펴보고자 하였다. 대상 및 방법 : 2000년 4월 1일부터 7월 1일까지 고신의료원 내분비내과를 방문한 환자 중 Graves병 46예, 만성갑상선염 6예 및 고신의료원 건강증진센터를 방문한 환자 중 갑상선질환의 병력이나 가족력 및 알레르기성 비염의 병력이 없는 35예의 정상대조군을 대상으로 연구를 시행하였다. TRAb는 갑상선자극호르몬 결합 억제 면역글로불린(TBII)으로 측정하였으며, IgE는 효소면역분석법으로 측정하였다. 결과: IgG인 TBII는 Graves병에서 만성갑상선염과 대조군에 비해 높았으며, IgE 평균농도는 Graves병에서 598.1±1112.9U/mL로 만성갑상선염 환자의 98350±79.7U/mL, 대조군 161.72±194.4U/mL에 비해 높았다(p<0.05). Graves병에서 알레르기성 비염의 발병율은 10.9%(5/46)였으며, Graves 병에서의 혈청 IgE 농도는 알레르기성 비염의 병력이 있는 경우 903.1±1152.2U/mL로 없는 경우 560.8±1117.0U/mL보다 높은 경향을 보였다. Graves병의 병기에 따른 TBII와 IgE 농도의 변화를 항갑상선제로 치료하지 않은 군(비치료군)과 치료한 군(치료군) 및 재발군으로 나누어 비교하였을 때, TBII는 치료군(7.4±18.6%)에 비해 비치료군(49.9±23.9%)과 재발군(21.1±3.1%)에서 높았으며(p<0.05), 혈청 IgE치도 치료군(233.8±432.7U/mL)에 비해 비치료군(758.6±1250.0U/mL)과 재발군(1198.5±1952.1U/mL)에서 높은 경향을 보였다. 항갑상선제로 치료한 치료기간에 따른 TBII와 IgE 농도 변화에서, TBII는 비치료군(49.9±23.9%)과 1년 미만 치료군(24.8±3.8%)에서 1년 이상 치료군(2.22±1.97%)에 비해 높았으며(p<0.05), 혈청 IgE 농도는 비치료군(758.6±1250.2U/mL)에서 1년 미만 치료한 군(158.3±91.5U/mL)과 1년 이상 치료군(252.7±483.4U/mL)에 비해 높았으나 유의하지는 않았다. 결론: Graves 병에서 IgE 농도는 증가되어 있었으며, Graves 병의 각각 다른 병기에서의 혈청 IgE 농도의 변화는 Graves qudd의 경과에 영향을 미치는 IgG인 TBII치의 변화와 유사한 경향을 보였다. 그러나 혈청 IgE와 Graves 병과의 연관성을 알아보기 위해서 IgE와 더불어 CD23항원 등의 다른 검사도 병행하는 전향적 연구가 필요할 것으로 생각된다. Background: It is widely believed that Graves' disease is and autoimmune disorder characterized by the presence of the circulation TSH receptor antibody (TRAb). The majority of the activity of TRAb is of the immunoglobulin G(IgG) class. However, other immunoglobulin such as immunoglobulin E(IgE), may play a rloe in the activity. IgE accumulation has been reported to occur in the thyroid gland and ocular muscles of subjects with Graves' disease. Furthermore, it has been noted that recurrence of Graves' disease can be induced by and allergy to pollen. Because an allergy to pollen is commonly associated with IgE, IgE might play a role in the induction of Graves' disease. Therefore, investigated whether IgE was elevated in Graves' disease, and evaluated the potential relationship between the levels of TRAb and IgE Graves' disease. Methods: Forty-six patients with Graves' disease, and 6 with chronic thyroiditis, diagnosed at the Kosin Medical Center between April, 2000 and July, 2000 were included in this study. Thirty-five persons without thyroid disease or a history of allergic rhinitis were used as normal controls. The level or TRAb was measured using thyrotropin binding inhibitory immunoglobulin (TBII). Serum total IgE was measured using as enzymeimmunoassay method. Test for thyroid function, TBII and total IgE were performed in all cases, and the results statistically analyzed. Results: TBII, as IgG, and the serum IgE level were higher in the patients with Graves' disease, and the levels of the latter were 598.1±1112.9U/mL, 98.5±79.7U/mL and controls 161.7±194.4U/mL in the Graves' patients, those with thyroiditis and the controls, respectively (p<0.05). The prevalence of allergic rhinitis in Graves' disease was 10.9%. The serum IgE level in Graves' disease with, and without, allergic rhinitis were 903.1±1152.2U/mL and 560.8±1117.0U/mL, respectively, although there was no significancant difference between the two groups. According to the clinical stage, the serum TBII level was higher in the untreated Graves', and relapsed patients 49.9±23.9% and 21.1±3.1%, respectively, than in the treated group, 7.4±18.6% (p<0.05). The serum IgE level was higher in the untreated Graves' and relapsed patients 758.6±1250.2U/mL and 1198.5±1952.1U/mL, respectively, than in the treated group 233.8±432.7U/mL, although this was not significant. According to the duration of treatment, the serum TBII levels were higher in the untreated Graves' patients, and those treated for less than 1 year, than in those treated for more than 1 year, with values of 49.9±23.9, 24.8±3.8 and 2.22±1.97%, respectively (p<.05). The serum IgE level was higher in the untreated Graves' disease (758.6±1250.2U/mL) than in the groups treated for less than 12 months (158.3±91.5U/mL) and more than 12 months (252.7±483.4U/mL), but the differences were not significant. Conclusions: The concentration of IgE was high in Graves' patients, and although not statistically significant, the serum igE level in Graves' patients with allergic rhinitis was higher than those without. With regard to the clinical stage of Grave's disease, the change in the IgE level tended to follow that of the TBII. Further study will be required to define the possible role of IgE in the pathogenesis in Graves' disease (J Kor Soc Endocrinol 17:640∼648, 2002).

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교 의학부 2000 高神大學校 醫學部 論文集 Vol.15 No.1

Background Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and 2 adenomatous goiter, and 1 Hu¨rthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7%(3/28) in solitary nodule and 8.1%(3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1㎝ or less, 27 cases (41.4%) between 1.0㎝ to 3.0㎝, and 2 cases (0.32%) above 3㎝, and malignant nodules were 3 (11.1%), 2(7.4%), and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5㎝ and 4.2㎝. Three of malignant nodules were microcarcinoma (≤1㎝) and the smallest one (0.5㎝) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin(TBⅡ) in the malignant patients were 9.2% to 350.0% and TBⅡ was positive in the 4 of 6 cases of malignacy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest on of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교(의대) 고신대학교 의과대학 학술지 2000 고신대학교 의과대학 학술지 Vol.15 No.1

Background : Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods : Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results : Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade to seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and adenomatous goiter, and 1 Hurthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7% (3/28) in solitary nodule and 8.1% (3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1cm or less, 27 cases (41.4%) between 1.0cm to 3.0cm, and 2 cases (0.32%) above 3cm, and malignant nodules were 3 (11.1%), 2 (7.4%) and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5cm and 4.2cm. Three of malignant nodules were microcarcinoma (≤1cm) and the smallest one (0.5cm) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin (TBII) in the malignant patients were 9.2% to 350.0% and TBII was positive in the 4 of 6 cases of malignancy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion : The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest one of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교 의학부 2000 고신대학교 의학부 학술지 Vol.15 No.1

그레이브스병에서 치료에 따른 폐동맥압의 변화

남택만,조한수,이진서,송영림,김두만,두영철,박철영,정인경,홍은경,이성진,오기원,김현규,유재명,최문기,유형준,박성우 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경: 갑상선기능항진증에 의한 갑상선중독증 환자들은 호흡곤란을 호소하며, 그 원인으로 호흡근의 근력 약화, 좌심실부전으로 인한 폐모세혈관의 울혈, 기도저항의 증가, 갑상선종으로 인한 기관의 압박, 호흡기능 이상 등이 거론되고 있다. 폐동맥고혈압이 동반된 그레이브스병 환자가 여러 증례가 보고되었으며, 폐동맥고혈압 환자에게서 갑상선 자가항체와 갑상선기능저하증의 빈도가 높음이 알려지면서 갑상선중독증이 동반된 그레이브스병 환자에게서 관찰되는 호흡곤란의 한 원인으로 폐동맥압 증가가 작용할 가능성이 제시되고 있다. 이에 저자 등은 그레이브스병 환자를 대상으로 폐동맥압을 측정하고 치료 전후의 폐동맥압의 변화를 전향적으로 연구하였다. 방법: 갑상선중독증이 동반된 그레이브스병 환자와 정상 갑상선기능을 나타낸 대조군을 대상으로 갑상선기능검사 및 갑상선 자가항체를 측정하고, 심초음파를 이용하여 치료 전후로 폐동맥압을 측정하여 폐동맥압과 갑상선기능 및 갑상선 자가항체와의 관계, 폐동맥압의 변화 등을 관찰하였다. 결과: 1. 연구대상은 대조군 10명 (남녀비 1:9, 관해 상태의 그레이브스병 3명, 갑상선종 3명, 정상인 4명), 그레이브스병 환자 26명 (남녀비 7:19)이었다. 2. 대조군과 치료 전 그레이브스병 환자의 폐동맥압은 각각 23.5±2.32 mmHg, 29.6±10.3 mmHg이었고, 치료 전의 폐동맥압과 혈청 갑상선자극호르몬 결합억제 면역글로불린 (TBII) 농도는 유의한 양의 상관관계를 보였다. 3. 26명의 그레이브스병 환자 중에서 10명 (38.5%)이 폐동맥고혈압 (기준: 폐동맥압 > 30 mmHg)으로 진단되었다. 4. 치료 전후로 폐동맥압을 측정한 13명은 폐동맥압이 치료 전 29.6±10.3 mmHg에서 치료 후 폐동맥압 22.2±6.48 mmHg로 의미있게 감소하였다. 결론: 갑상선중독증을 보이는 그레이브스병 환자의 약 40% 정도에서 폐동맥고혈압이 발견되어 폐동맥고 혈압은 그레이브스병에 흔하게 동반하는 질환으로 생각된다. 향후 그레이브스병 환자에서 관찰되는 폐동맥압의 증가와 관련한 병인, 발생기전 및 임상적 의의 등에 대한 연구가 필요할 것으로 생각된다. Background: Exertional symptoms, dyspnea and impaired effort tolerance are common in patients with Graves' disease. Proposed explanations include: high-output left heart failure, ineffective oxygen utilization and respiratory muscle weakness. In addition, pulmonary hypertension has also been reported in patients with Graves' disease. A high prevalence of hypothyroidism and positive thyroid autoantibody were also observed in patients with pulmonary arterial hypertension. Therefore, the pulmonary artery pressure in patients with Graves' disease was evaluated. Methods: Two-dimensional and Doppler echocardiographic examinations (Hewlett Packard Sonos 2500) were performed to determine the pulmonary artery (PA) pressure in 26 Graves' disease patients, both before and after treatment (23 patients with propylthiouracil and 3 with RAI), and in 10 euthyroid controls. The changes in the PA pressure after treatment were evaluated in 13 patients with Graves' disease, who became euthyroid after treatment. Results: The pulmonary artery pressure was increased in the untreated Graves' disease patients compared to the normal controls (23.5±2.32 vs. 29.6±10.3 mmHg). 38.5% of the Graves' disease patients (10/26) showed pulmonary arterial hypertension (PA>30 mmHg) and the serum TBII level was higher in the Graves' disease patients with pulmonary arterial hypertension than in those with normal PA pressure (P<0.05). In the Graves' patients who became euthyroid after treatment, the PA pressure was significantly decreased. Conclusion: 38.5% of the untreated Graves' disease patients showed pulmonary arterial hypertension, and the pulmonary artery pressure was significantly decreased in those who became euthyroid after treatment. The pathogenesis and clinical importance of pulmonary arterial hypertension in Graves' disease requires further studies (J Kor Soc Endocrinol 18:465∼472, 2003).

한국인 Graves씨병에 있어서의 HLA항원 분포에 관한 연구

허갑범,이혜리,이상용,박기일,김춘규,김윤정,송경순,이삼열 인제대학교 1982 仁濟醫學 Vol.3 No.1

Graves씨병은 자가면역성 갑상선 질환의 하나로 유전적인 요소가 중요한 역활을 한다. Graves씨병에 대한 감수성과 HLA항원 분포와의 연관성을 극명하기 위해 한국인 Graves씨병 52예를 대상으로 HLA항원 분포를 검사하고 정상대조군 72예와 비교 분석하여, 외국과는 달리 Graves씨병 환자에서 HLA-All 증가되는 반면 HLA-B locus 항원에서는 유의한 차이가 없음을 관찰하였다. Graves' disease is one of the autommune thyroid diseases and genetic factors seem to play an important role in the pathogenesis of Craves' disease. Lymphocytes of 52 Korean patients with Graves' disease and 72 normal unrelated controls were examined for HLA antigens by the microcytotoxicity test. Also antithyroglobulin and antimicrosomal autoantibody tests were performed on 43 patients with Graves' disease The following results were obtained: 1.The frequency of the HLA-A11 antigen in patients with Graves' desease was increased to 30.8% compared to 12.5% incontrols (p<0.025). 2.There's no consistent association between Graves' disease and HLA-B locus antigens including B8 and Bw35 which were significantly increased in Caucasians and Japaneses, respectively. 3.No significant differences of HLA antigens were present at the HLA-C locus. 4.No significant correlation was observed between the frequency of thyroid autoantibodies and HLA antigens in Korean patients with Graves' discase. In summary, these results showed close association between Graves' disease and HLA-A locus antigen(A11) but no significant correlation with HLA-B locus antigens in Korean patients with Graves' disease. These findings might suggest racial difference.

Ultrasonographic Features of Papillary Thyroid Carcinoma in Patients with Graves` Disease

( Jin Ook Chung ),( Dong Hyeok Cho ),( Dong Jin Chung ),( Min Young Chung ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

Background/Aims: To characterize ultrasonographic findings in papillary thyroid carcinoma (PTC) combined with Graves` disease. Methods: Medical records and ultrasonographic findings of 1,013 patients with Graves` disease and 3,380 patients without Graves` disease were analyzed retrospectively. A diagnosis of PTC was based on a pathologic examination. Results: The frequency of hypoechogenicity was lower in patients with PTC and Graves` disease than in patients with PTC alone (p<0.05). The frequency of perinodular blood flow in patients with PTC and Graves` disease was significantly higher than in those with PTC alone (p<0.05). PTC combined with Graves` disease was characterized by more ill-defined borders and less frequency of overall calcification, punctate calcification, and heterogeneous echogenicity, although the difference was not statistically significant. Conclusions: Our results suggest that patients with Graves` disease more frequently have atypical PTC findings on ultrasonography. (Korean J Intern Med 2010;25:71-76)

갑상선중독증에서 그레이브스병과 무통성 갑상선염 감별을 위한 총 T3/유리 T4 비의 유용성

이상민,김수경,함종렬,정정화,김호수,김성수,정순일,최봉희,정태식 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.2

Background: It is important to differentiate Graves’ disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves’ disease and painless thyroiditis. Methods: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves’ disease or painless thyroiditis,from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone,thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves’ disease and painless thyroiditis patients. Results: A total of 76 untreated thyrotoxic patients “49 Graves’ disease and 27 painless thyroiditis” were examined. The total T3,free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves’ disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves’ disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4< 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). Conclusion: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves’ disease and painless thyroiditis.

한국 소아 및 청소년 Graves병의 자연 경과 및 예후 인자

송승민,윤지석,고정민,전종근,최진호,유한욱,Song, Seung-Min,Youn, Ji-Seok,Ko, Jung-Min,Cheon, Chong-Kun,Choi, Jin-Ho,Yoo, Han-Wook 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

목 적: Graves병은 소아 및 청소년의 갑상선 기능항진증의 가장 흔한 원인으로 한국 소아 및 청소년 Graves병의 자연 경과 및 예후 인자를 알아보기 위하여 이 연구를 시행하였다. 방 법: 1991년 11월부터 2006년 7월까지 15년간 서울아산병원 소아청소년과에서 Graves병으로 진단 받고 2년 이상 추적관찰이 가능하였던 환자 113명(여자 88명, 남자 25명)을 대상으로 하였다. 성별, 진단 시 연령, 치료 기간, 혈액 검사, 임상 증상, 가족력을 후향적으로 분석하였다. 결 과 : 모든 환자들은 항갑상선제 투여로 치료를 시작하였고 7명(6.2%)에서 PTU, 106명(93.8%)에서 MZ을 투여하였다. 전체 환자 113명 중 75명(66.4%)은 첫 번째 관해가 되었으며, 이 중 23명(전체의 20.4%)은 약물 치료를 중단한지 평균 $25.5{\pm}33.7$개월 후 재발하였다. 재발한 23명 중 13명(전체의 11.5%)은 두 번째 관해가 되었으나 이 중 2명은 다시 재발하였다. 1명은 4년간의 약물 치료에도 정상 갑상선 기능이 되지 않아 방사선 요오드 요법을 시행하였다. 완전 관해군의 진단 시 연령이 질병 지속 상태군에 비해 의미 있게 높았다(12.7세 vs. 11.7세, $P$=0.034). 즉, 연령이 높은 경우 관해율이 높을 것으로 나타났다. 결 론: 진단 시 연령을 소아 및 청소년 Graves병의 예후 인자로 고려할 수 있으며 이는 Graves병의 치료 방법 및 기간을 결정하는데 도움이 될 것으로 생각된다. Purpose : Graves' disease is the most common cause of hyperthyroidism in children and adolescents. In this study, we investigated the natural course and the prognostic factors of Graves' disease in Korean children and adolescents. Methods : One-hundred thirteen (88 girls and 25 boys) patients were included in this study. A retrospective analysis was made of all patients who were diagnosed with Graves' disease. The following parameters were recorded and analyzed: patient's sex, age at diagnosis, duration of disease, laboratory findings, symptoms and signs, and family history of autoimmune thyroid disease. Results : All patients were initially treated with antithyroid drugs, either methimazole (93.8%) or propylthiouracil (6.2%). Antithyroid drugs had been discontinued in 75 (66.4%) of 113 patients. Of these 75 patients, 23 (20.4%) relapsed after $25.5{\pm}33.7$ months. Thirteen (11.5%) of 23 patients, who experienced the first relapse, showed a second remission. However, 2 (1.8%) of 13 patients relapsed again. Euthyroid state could not be achieved by antithyroid drugs in 1 patient, and radioactive iodine therapy was performed. The older the patient at diagnosis, the greater the likelihood of remission ($P$=0.034). Conclusion : Age at diagnosis seems to be a prognostic factor in Korean children and adolescents with Graves' disease, and should be taken into account in treatment plan determination.

Two adolescent patients with coexistent Graves' disease and Moyamoya disease in Korea

전종근,김수영,유재호 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.6

Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of thecircle of Willis and collateral vessel formation at the base of the brain. Although relationships betweenGraves’ disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence ofthe two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patientswith thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya diseaseassociated with Graves’ disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves’ disease had no history of other diseases or head trauma. A thyroidfunction test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibodytiter at that time. The patients were diagnosed with Moyamoya disease based on brain magneticresonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularizationby encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resultedin successful symptom resolution. They fared well and had no additional neurological symptoms as oftheir last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated byGraves’ disease with a review of the literature, and discuss the possible association between the twodiseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associatedwith Graves’ disease in adolescents with a euthyroid.