Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The natural history and prognostic factors of Graves' disease in Korean children and adolescents

한국 소아 및 청소년 Graves병의 자연 경과 및 예후 인자

  • Song, Seung-Min (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Youn, Ji-Seok (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Jung-Min (Department of Pediatrics, Ajou University School of Medicine) ;
  • Cheon, Chong-Kun (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Choi, Jin-Ho (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Han-Wook (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 송승민 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 윤지석 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 고정민 (아주대학교 의과대학 소아과학교실) ;
  • 전종근 (부산대학교 의과대학 소아과학교실) ;
  • 최진호 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 유한욱 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Received : 2009.08.10
  • Accepted : 2009.09.23
  • Published : 2010.04.15
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Abstract

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.

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.

Keywords

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