Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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1형 당뇨병 환자에서 갑상선 질환이 발생한 경우의 임상적 특성

Clinical Characteristics of Autoimmune Thyroid Disease Developed in Patients with Type 1 Diabetes Mellitus

  • 이세민 (서울대학교 의과대학 소아과학교실) ;
  • 정혜림 (서울대학교 의과대학 소아과학교실) ;
  • 홍수영 (서울대학교 의과대학 소아과학교실) ;
  • 신충호 (서울대학교 의과대학 소아과학교실) ;
  • 양세원 (서울대학교 의과대학 소아과학교실)
  • Lee, Se Min (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Chung, Hye Rim (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Hong, Su Young (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Shin, Choong Ho (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yang, Sei Won (Department of Pediatrics, Seoul National University College of Medicine)
  • 투고 : 2004.09.14
  • 심사 : 2004.10.12
  • 발행 : 2005.03.15
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초록

대 상 : 1981년 1월부터 2004년 7월까지 서울대학교병원 소아과에서 추적 중인 1형 당뇨병 환자 일부에서 후향적으로 의무기록 분석을 시행하였다. 방 법 : Anti-TG Ab, anti-TPO Ab를 방사면역방법으로 측정하였으며, 둘 중 하나라도 양성인 경우에는 자가면역성 갑상선염이 있는 군(갑상선 질환군)으로 정의하였다. 두 항체 모두 음성이며, 갑상선 수용체 항체(TSHRAb)가 음성인 경우는 자가면역성 갑상선 질환이 없는 군(갑상선 비질환군)으로 정의하였다. TSHRAb가 양성인 Graves병 환자는 갑상선 질환군에 포함시켰다. 결 과 : 총 139명에서 검사를 시행하였으며, 남아 44명(연령 $14.4{\pm}4.8$, 5.9-26.6세), 여자 95명(연령 $13.6{\pm}5.4$세, 3.6-30세)이었다. 갑상선 질환군과 비 갑상선 질환군에서 성비, 당화혈색소, 체질량지수, 당뇨병의 발병연령, 갑상선 질환의 가족력에서 두 군 간에 통계적으로 유의한 차이는 없었다. 갑상선 질환은 남자에서는 역연령 5.0-9.9세 사이에서 검사한 환자의 42.8%에서 발견되었고 여자에서는 역연령 10-14.9세, 15-19.9세에서 각각 56.5%와 50.0%에서 발견되어 남자가 여자에 비해 상대적으로 낮은 연령에서 흔하게 발생하였다. 자가면역성 갑상선 질환은 갑상선종이 있는 경우에서 없는 경우보다 흔하게 발견되었고 갑상선종이 동반된 경우에 남녀간의 발생빈도의 차이는 없었다. 갑상선 기능은 정상 기능을 유지하는 경우가 74%였고, 기능저하와 기능항진은 각각 13%로 동일한 비율을 보였다. 결 론 : 1형 당뇨병 환자에서는 10세 이상의 연령에서 갑상선 기능검사와 자가항체검사가 필요한데 특히, 갑상선종이 발견되거나 남아에서는 최소 8세가 되면 갑상선 기능검사와 항체검사를 시행하고 지속적으로 추적하는 것이 바람직할 것으로 생각된다.

Purpose : It is known that 3-50 percent of type 1 diabetes mellitus(T1DM) patients develop autoimmune thyroid disease. We analyzed the clinical characteristics of autoimmune thyroid disease(AITD) developed in patients with T1DM in Korean. Methods : The medical records of 139 patients, who were followed up in Department of Pediatrics, Seoul National University Children's Hospital from Jan. 1981 to Jul. 2004, were analyzed retrospectively. Results : Forty-four males and 95 females were enrolled. At least one of the autoantibodies for thyroid was positive in 54 cases. The detection rate for AITD was not correlated with sex ratio, control of T1DM, body mass index, age at diagnosis of T1DM, and familial history of thyroid disease, between two groups. In the male group, AITD was more frequently found at a younger age than in the female group. The frequency of AITD was significantly higher in the goiter group without sex differences. In the thyroid disease group, 40 patients(74.0 percent) were euthyroid, seven patients(12.9 percent) were hypothyroid, and seven patients(12.9 percent) were hyperthyroid. Conclusion : We should monitor thyroid function and autoantibodies routinely in T1DM patients who develop goiters, or young boys with T1DM.

키워드

참고문헌

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