갑상선장애 환자에서 나타나는 인지기능 장애의 특징 및 관련요인

이지상,전진숙,변현우,김강률,이지웅,최영식,오병훈 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2

Objectives:The aims of this study were to examine changes of cognitive function and its characteristics, and to identify influencing factors on cognitive fuction in patients with thyroid disorders. Methods:Data of 98 patients with thyroid disorders(16 males and 82 females) recruited from thyroid clinic in the Endocine Center of Kosin University Gospel Hospital were obtained by semi-structred interviews and MoCA-K(Korean Version of the Montreal Cognitive Assessment) and Korean version of the HDRS-17(Hamilton Depression Rating Scale-17). Results:1) The cognitive dysfunction was seen in 24 patients with thyroid disorders(24.49%). The total scores of the MoCA-K tests in thyroid patients with cognitive dysfunction(18.42±3.75) were significantly(p<0.001) lower than those of controls(26.43±2.01). Their subtest scores of the MoCA-K such as visuospatial/executive, naming, attention, language, abstraction, delayed recall were also lower than those of controls. 2) The thyroid patients with MoCA-K ≤22 showed higher age and onset age of thyroid disorders, and had lower education and HDL-cholesterol(p<0.001 respectively). 3) Total scores of the MoCA-K tests in patients with thyroid disorders had positive correlation with education(ρ=0.583, p<0.01), and had negative correlation with age(ρ=-0.462, p<0.01) and onset age of thyroid disorders(ρ=-0.494, p<0.01). Otherwise, triiodothyronine and HDL-cholesterol had positive correlation, and sex and triglyceride had negative correlation with some subtest scores of the MoCA-K. Conclusions:The cognitive dysfunction accompanied in about 1/4 of patients with thyroid disorders. The finding that the cognitive function in thyroid disorders seemed to be mainly associated with age and onset age of thyroid disorders, suggested a possibility of an important role of aging mechanism.

전신성 홍반성 낭창에서 갑상선질환의 유병률

박동준(Dong Jun Park),김정아(Jeong A Kim),박성환(Sung Hwan Park),이상헌(Sang Heon Lee),조철수(Chul Soo Cho),김호연(Ho Youn Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.4

N/A Background: Autoimmune diseases are occasionally associated with other autoimmune diseases in the same patient. Autoimmune thyroid diseases have been associated with systemic rheumatic diseases including systemic lupus erythematosus (SLE). Thyroid disorders developed in SLE are Graves disease, Hashimoto`s thyroiditis, subacute thyroiditis, nontoxic goiter, and euthyroid sick syndrome. To determine the prevalence of thyroid disorder in Korean patients with SLE, we analysed thyroid function and disease in 61 consecutive patients with SLE. Methods: T3, T4, free T4, and TSH were measured by radioimmunoassay. Anti-microsomal antibody (AMA) was measured by passive hemagglutinin assay. Anti-thyroglobulin antibody (AMA) was measured by passive hemagglutinin assay and anti-thyroglobulin antibody (ATA) by immunoradiometric assay. In some patients who showed hyperthyroidism or goiter, thyroid scan and uptake study were performed. Results: 1) Goiter was the initial manifestation of disease in 3 cases (5% of total) who diagnosed Hashimoto`s thyroiditis. 2) On the concurrent thyroid function test results in 61 patients, 44 (72.1% of total) revealed normal thyroid, 9 (14.8%) revealed euthyroid sick syndrome, 5 (8.2%) revelaed biochemical hypothyroidism, 2 (3.3%) revealed hyperthyroxinemia/hypertriiodothyroxinemia, and 1 (1.6%) revelaed subclinical hypothyroidism. 3) Of 18 SLE patients with thyroid disorders, 9 (50%) had euthyroid sick syndrome, 5 (27.8%) had Hashomoto`s thyroiditis with hypothyroidism, 2 (11.1%) had Graves` disease, 1 (5.5%) had idiopathic hypothyroidism, and 1 had benigh thyroid nodule. 4) Serum globulin, serum IgG, AMA titer, and ATA titer of group II (hyper-or hypothyroidism, 8 cases) were significantly higher than those of group I (normal thyroid, 44 cases). ATA titer of group II was higher than that of group III (euthyroid sick syndrome, 9 cases). Conclusion: These results suggested that autoimmune thyroid diseases could be a initial manifestation or a manifestation of SLE. Also high titer of AMA or ATA should be a possible predictor of autoimmune thyroiditis developed in SLE.

건강검진에서 시행한 갑상선기능검사 이상에 대한 고찰

박지은,조호찬 대한갑상선학회 2012 International Journal of Thyroidology Vol.5 No.1

Background and Objectives: Thyroid disorders are common endocrine disease with various clinical symptoms. Biochemical function tests are important to detect thyroid function disorders, but guideline for screening of thyroid dysfunction is controversial. Therefore, in this study, we aimed to investigate the prevalence and clinical significance of thyroid dysfunctions with analyses of public screening and follow-up results on our hospital. Materials and Methods: This study was performed on 3309 subjects (1753 men, 1556 women) that visited in our health promotion center for periodic health examination from January to June 2007, with review of medical records. Serum T3, Free T4, and thyroid-stimulating hormone concentrations were measured with radioimmunoassay using commercial kits, and ultrasonogram and scan of thyroid were conducted if needed. Results: The study showed the prevalence of thyroid dysfunction was 11.8% (389 cases) and among the subjects, prevalence of undiagnosed hyperthyroidism and hypothyroidism were 1.8% (7 cases) and 3.1% (12 cases), subclinical hyperthyroidism and subclinical hypothyroidism was 0.5% (2 cases) and 4.9% (19 cases). However, prevalence of normal thyroid function with follow up clinically was 37.3% (145 cases). Conclusion: This study indicates significance of screening and confirmation through follow-up for thyroid disorders with high prevalence of thyroid dysfunctions with guidelines to minimize the false positive results.

갑상선장애 환자에서 불면증에 연관되는 인자

김민수(Min Soo Kim),전진숙(Jin Sook Cheon),최영식(Young Sik Choi),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.3

Objectives:The aims of this study were to know the frequency and clinical characteristics of insomnia, and related various factors to insomnia in patients diagnosed with thyroid disorders. Methods:For 90 patients with thyroid disorders, interviews were performed. The data were obtained from interviews from about history and assessment of insomnia and depression. Insomnia was evaluated using the Korean Version of the Insomnia Severity Index(ISI-K). According to the cutoff score of 15.5 on the ISI-K, subjects were divided into the group of thyroid patients with insomnia(n=21) and those without insomnia(n=69) at first, and then statistically analyzed. Results:1) Insomnia is found in 23.33% of patients with thyroid disorder. 2) Insomnia in patients with thyroid disorder had significantly more comorbidities of physical and psychiatric illnesses(p<0.005, respectively), more hyperthyroidism (p<0.01), higher T3(p<0.05), and longer than 60 minutes of sleep latency(p<0.001). 3) Among scores of the ISI-K, total scores(p<0.001), and scores for initial sleep(p<0.05), sleep satisfaction(p<0.005) and distress(p<0.05) were significantly higher in insomnia in patient with thyroid disorder. Conclusion:Insomnia is not rare among patients with thyroid disorder. According to the presence of insomnia, clinical characteristics including sleep quality as well as quantity seemed to be different.

갑상선질환 환자에서의 피부증상에 관한 연구

목혜수(Hae Soo Mok),권경술(Kyung Sool Kwon),정태안(Tae Ahn Chung) 대한피부과학회 1985 대한피부과학회지 Vol.23 No.5

The clinical investigation was performed regarding cutaneous manifestations in 495 patients with thyroid disorders who had visited Pusan National University Hospital from January, 1979 to April, 1984. The results of this study were as follows: I. Of the 495 patients with thyroid disorders, 417 patients(84. 2%) showed various cutaneous manifestations. Among the cutaneous manifestations presented in the 176 patients with hyperthyroidism, hyperhidrosis was the most common(24. 2%), followed by pruritus (42. O%), chronic urticaria(29, 5%), bronze appearance(21. 6%), sparsity of hair (20. 5%), soft and friable nail(17. 6%). 3. Among the cutaneous manifestations presented in the 57 patients with hypothyroidism, pruritus was the most common(26. 3%), followed by sparsity of hair (21. 1%,), chronic urticaria(19. 3%), soft and friable nail(14. 0%). 4. In patients with Graves disease, cutaneous manifestations were more frequently observed than those of other thyroid disorders. 5, Autoimmune thyroid disorders such as Graves' di ease and Hashimotos thyroiditis were rarely associated with vitiligo(only 2 cases) and alopecia areata(only 1 case).

건강한 성인에서 초음파로 발견된 무증상 갑상선 질환에 대한 분석

소중해,김상용 조선대학교 의학연구원 2015 The Medical Journal of Chosun University Vol.40 No.4

The objective of this study is to access the prevalence of diffuse thyroid disorders by using ultrasonography in healthy adults. Among 1535 adults who underwent thyroid ultrasonography, thyroid disorders were detected in 191 subjects (12.4%). There was a rapid increase of thyroid functional abnormalities in addition to subclinical thyroid disease with more than 3 features of diffuse thyroid disorder. Therefore we suggest that the thyroid function test and thyroid auto-antibodies should be checked when there are more than 3 features of the diffuse thyroid disorder in ultrasonographic examination, even if the patient does not have any symptoms.

An overview of the pathogenic mechanisms of autoimmune thyroid disorders

박근용 고신대학교(의대) 고신대학교 의과대학 학술지 2014 고신대학교 의과대학 학술지 Vol.29 No.2

Objectives, recent epidemiologic studies in humans suggest an increased prevalence of thyroiditis associated with the excessive administration of iodine. More than three times of recommended daily intake of iodine was observed among people in North America. These people generally presented higher level of anti-thyroglobulin antibody, anti-thyroperoxidase antibody, serum thyroid-stimulating hormone and exacerbation of lymphocytic infiltration in thyroid, which indicated the overconsumption of iodine could induce hypothyroidism and enhance the autoimmune response. However, the precise mechanism of excessive iodine intake induced autoimmune thyroid disease remains largely unknown. Over half a century has elapsed since the 1956 identification of thyroglobulin antibodies and the devising of the first experimental model of autoimmune thyroiditis. Since then an incredible amount of experimental work has led to an ever deeper understanding of the nature of thyroid auto-antigens, the main immune mechanisms responsible for Hashimoto's thyroiditis and graves’ disease, their genetics, and therir environmental risk factor. Yet, in the majority of genetically predisposed people the individual trigger of thyroid autoimmunity remains obscure. Similarly, effective prevention strategies still remain to be established and, hopefully, will be the target of future studies.

Prenatal Exposure to Per- and Polyfluoroalkyl Substances, Maternal Thyroid Dysfunction, and Child Autism Spectrum Disorder

신형무,Jiwon Oh,Rebecca J. Schmidt,Elizabeth N. Pearce 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.6

Autism spectrum disorder (ASD), with its high economic and societal costs, is a growing public health concern whose prevalence has risen steadily over the last two decades. Although actual increased incidence versus improved diagnosis remains controversial, the increased prevalence of ASD suggests non-inherited factors as likely contributors. There is increasing epidemiologic evidence that abnormal maternal thyroid function during pregnancy is associated with increased risk of child ASD and other neurodevelopmental disorders. Prenatal exposure to endocrine-disrupting chemicals such as per- and polyfluoroalkyl substances (PFAS) is known to disrupt thyroid function and can affect early brain development; thus, thyroid dysfunction is hypothesized to mediate this relationship. The concept of a potential pathway from prenatal PFAS exposure through thyroid dysfunction to ASD etiology is not new; however, the extant literature on this topic is scant. The aim of this review is to evaluate and summarize reports with regard to potential mechanisms in this pathway.

외상후 자극장애와 갑상선 기능

박성덕,정문용,정영기 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.1

This study was conducted to investigate the thyroid function of patients with posttraumatic stress disorder. Subjects consisted of 30 PTSD patients and 23 control patients who visited the department of psychiatry of Korea Veterans Hospital from March 1, 1991 to June 30, 1991. Controls consisted of patients with somatization disorder(8 cases), sleep disorder(9 cases) or personality disorder(6 cases). Authors studied the relationship between PTSD and thyroid function by measuring serum triiodothyronine(T3), thyroxine (T4), free thyroxine(FT4) and thyroid stimulating hormone (TSH) and compared it with the data from control patients who also had combat experiences. And we studied the correlation between thyroid function and Hamilton's anxiety (HAS) and depression(HDS) scales. The results were as following : 1) The serum level of T3 of the PTSD group were significantly higher than that of the control group(p<0.05). 2) The serum levels of T4, FT4 and TSH of the PTSD group were slightly higher than those of the control group with no statistical significance. 3) Total scores of HAS and HDS were moderately correlated with the value of T3, but they were not significantly correlated with the value of T4. FT4 and TSH.

자가면역 갑상선장애 환자에서 삶의 질의 결정인자

이윤나 ( Yunna Lee ),전진숙 ( Jin Sook Cheon ),최영식 ( Young Sik Choi ),오병훈 ( Byoung Hoon Oh ) 한국정신병리진단분류학회 2015 精神病理學 Vol.23 No.1

연구목적 : 자가면역 갑상선장애 환자에서 삶의 질(quality of life, 이하 QoL) 저하 여부와 이들의 QoL에 관계되는 변인을 규명하기 위함이다. 연구방법 : 자가면역 갑상선장애 환자 41명과 건강한 대조군 40명을 대상으로 구조적 면담과 한국판 세계보건기구 삶의 질 간편형 척도(WHOQOL-BREF)를 사용한 QoL 평가 및 한국판 Hamilton 우울증 평가척도(K-HDRS)를 사용한 우울증 평가를 시행하였다. 연구결과 : 1) 자가면역 갑상선장애 환자군은 대조군 보다 유의하게 전체 QoL 점수, 일반적 건강, 영역1(신체적 건강 영역), 영역 2(심리적 영역), 영역 3(사회적 관계 영역) 및 영역 4(환경적 영역) 점수가 낮았다(각각 p<0.001). 2) 전반적 QoL은 K-HDRS 점수 및 경제수준, 일반적 건강은 K-HDRS 점수와 유의한 역상관관계가 있었다(각각 p<0.01). 전체 QoL 점수는 교육수준과 유의한 순상관관계, K-HDRS 점수 및 경제수준과 유의한 역상관관계가 있었다 (각각 p<0.01). 신체적 건강 영역은 K-HDRS 점수(p<0.01)와 유의한 역상관관계, antimicrosomal 항체(p<0.05)와 유의한 순상관관계가 있었다. 심리적 영역은 TSH와 유의한 순상관관계(p<0.05), K-HDRS 점수(p<0.01) 및 T3(p<0.05)와 유의한 역상관관계가 있었다. 사회적 관계 영역은 K-HDRS 점수와 유의한 역상관관계(p<0.01)가 있었다. 환경적 영역은 교육수준과 유의한 순상관관계, 경제수준과 유의한 역상관관계가 있었다(각각 p<0.01).3) 회귀분석에서 antimicrosomal 항체는 전체 QoL 점수에 역의 영향(β=-0.002)을 미쳤으며, 전반적 QoL(β=0.037), 일반적 건강(β=0.023), 신체적 건강 영역(β=0.003), 심리적 영역(β=0.006), 사회적 관계 영역(β=0.013) 및 환경적 영역(β=0.004)에 순의 영향을 미쳤다(각각 p<0.01). 결론 : 본 연구의 결과는 자가면역 갑상선장애 환자에서 삶의 질 저하에 가장 중요한 결정인자는 갑상선항체 (antimicrosomal 항체)임을 시사하였다. Objectives : The aims of this study were to know whether quality of life (QoL) was lowered in patients with autoimmune thyroid disorders, and to identify influencing factors on their QoL. Methods : Demographic and clinical data were obtained by structured interviews for healthy controls (N=40) and patients with autoimmune thyroid disorders (N=41). The measurements of QoL and depression were also performed using Korean Version of WHOQOL-BREF and Korean Version of Hamilton Deression Rating Scale. Results : 1) The total QoL scores, general health, domain 1 (physical health domain), domain 2 (psychological domain), domain 3 (social relationship domain) and domain 4 (environmental domain) were significantly lower in patients with autoimmune thyroid disorder than those of healthy controls (p<0.001, respectively). 2) Overall QoL had negative correlation with K-HDRS and economic status, and general health had negative correlation with K-HDRS (p<0.01, respectively). Total QoL scores had positive correlation with education, and had negative correlation with K-HDRS and economic status (p<0.01, respectively). Physical health domain had negative correlation with K-HDRS (p<0.01), and had positive correlation with antimicrosomal antibodies (p<0.05). Psychological domain had positive correlation with TSH (p<0.05), and had negative correlation with K-HDRS (p<0.01) and T3 (p<0.05). Social relationship domain had negative correlation with K-HDRS (p<0.01). Environmental domain had positive correlation with education, and had negative correlation with economic status (p<0.01, respectively). 3) According to regression analysis, antimicrosomal antibodies influenced negatively on the total QoL scores (β=-0.002), and positively on the overall QoL (β=0.037), general health (β=0.023), physical health domain (β=0.003), psychological domain (β=0.006), social relationship domain(β=0.013) and environmental domain (β=0.004)(p<0.01, respectively). Conclusion : The thyroid antimicosomal antibodies seemed to be the most important determinant of QoL in patients with autoimmune thyroid disorders.