Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Remission rate and remission predictors of Graves disease in children and adolescents

소아 및 청소년 그레이브스병 환자에서의 관해 예측 인자와 관해율

  • Lee, Sun Hee (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Lee, Seong Yong (Department of Pediatrics, Seoul National University Boramae Hospital) ;
  • Chung, Hye Rim (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Kim, Jae Hyun (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Kim, Ji Hyun (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Lee, Young Ah (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Yang, Sei Won (Department of Pediatrics, College of Medicine, Seoul National University) ;
  • Shin, Choong Ho (Department of Pediatrics, College of Medicine, Seoul National University)
  • 이선희 (서울대학교 의과대학 소아과학교실) ;
  • 이성용 (보라매병원 소아청소년과) ;
  • 정혜림 (분당서울대학교병원 소아청소년과) ;
  • 김재현 (서울대학교 의과대학 소아과학교실) ;
  • 김지현 (서울대학교 의과대학 소아과학교실) ;
  • 이영아 (서울대학교 의과대학 소아과학교실) ;
  • 양세원 (서울대학교 의과대학 소아과학교실) ;
  • 신충호 (서울대학교 의과대학 소아과학교실)
  • Received : 2009.04.22
  • Accepted : 2009.08.05
  • Published : 2009.09.15
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Abstract

Purpose:Medical therapy is the initial treatment for children with Graves disease to avoid complications of other treatments. However, optimal treatment for childhood Graves disease is controversial because most patients require relatively long periods of medical therapy and relapse is common after medication discontinuation. Therefore, this study aimed to search clinical or biochemical characteristics that could be used as remission predictors in Graves disease. Methods:We retrospectively studied children diagnosed with Graves disease, treated with anti-thyroid agents, and observed for at least 3 years. Patients were categorized into remission and non-remission groups, and the groups were compared to determine the variables that were predictive of achieving remission. Results:Sixty-four patients were enrolled, of which 37 (57.8%) achieved remission and 27 (42.2%) could not achieve remission until the last visit. Normalization of thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) after treatment was faster in the remission group than in the non-remission group (remission group, $15.5{\pm}12.07$ vs. non-remission group, $41.69{\pm}35.70$ months). Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 28 patients. Only 2 (8.3%) of 26 patients who showed normal or hyper-response in TRH stimulation test relapsed. Binary logistic regression analysis identified rapid achievement of TBII normalization after treatment as a significant predictor of remission. Six percent of patients achieved remission within 3 years and 55.8% achieved it within 6 years. Conclusion:Rapid achievement of TBII normalization can be a predictor of remission in childhood Graves disease. The TRH stimulation test can be a predictor of maintenance of remission.

목 적:저자들은 그레이브스병으로 인한 갑상샘기능항진증을 가진 소아나 청소년에게 항갑상샘 약물 치료 전, 치료 중, 그리고 치료 종료 시에 관해를 예측할 수 있는 예측인자를 각각 찾아보고 그레이브스병의 관해율을 알아보고자 하였다. 방 법:그레이브스병으로 인한 갑상샘기능항진증으로 진단받고 3년 이상 외래 추적 관찰이 가능했던 64명의 환자를 관해를 획득한 군과 관해를 획득하지 못한 군으로 나누어 후향적으로 진단 당시의 갑상선 기능 검사와 TBII, 진단 당시 Tanner stage, 갑상샘 질환 가족력, 발현시의 증상, TBII가 정상화되는 시기와 TRH 자극 검사 시행 여부 등을 조사 분석하였다. 결 과:총 64명의 환아 중 관해가 온 환아는 37명(57.8%), 마지막 외래 추적 관찰 때 까지 관해가 오지 않은 환아는 27명(42.2%)이었다. 관해를 획득한 군과 관해를 획득하지 못한 군에서 성별이나, 발병 당시 나이, 안구돌출 여부나 진단 당시 갑상샘종의 크기, 갑상샘 질환의 가족력, 그리고 진단 당시 갑상샘 기능 검사나 TBII 수치도 차이가 없었다. 약물 치료 후 TBII가 정상화되기까지 걸리는 기간은 관해를 획득한 군은 평균 $15.5{\pm}12.07$개월, 관해를 획득하지 못한 군은 $41.69{\pm}35.70$개월로 관해를 획득한 군에서 관해를 획득하지 못한 군에 비해 유의하게 짧았다(P<0.05). 관해에 도달 한 후 TRH 자극 검사를 시행한 28명의 환아 중 정상 또는 과도한 반응을 보인 26명 중 24명(92.8%)은 마지막 외래 추적 관찰 시까지 관해를 유지하고 있었고 오직 2명(7.7%)에서만 재발하였다. 로지스틱 회귀 분석을 통해 약물 치료 후 TBII가 빨리 정상화 되는 경우 관해가 올 가능성이 높음을 알 수 있었다. 그리고 본 연구에서의 관해율은 3년에 6.3%, 6년에 55.8%로 나타났다. 결 론:치료 중 TBII가 빨리 정상화되는 것은 소아 및 청소년 그레이브스병 환자의 관해여부를 예측할 수 있는 인자가 될 수 있을 것으로 생각되며 약물 중단 시에는 TRH 자극 검사가 그레이브스병이 재발 없이 관해를 유지할 수 있는지 예측 하는데 도움을 줄 수 있을 것으로 생각된다.

Keywords

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