Graves병 환자에 있어 항갑상선제 치료효과에 관한 연구

Abstract

[한글]

Graves병의 치료방법에는 여러 가지가 있으나 모두 항진된 갑상선 기능을 억제하여 정상 기능을 유지시키는데 있다. Graves 병의 치료법으로는 항갑상선제는 비교적 널리 사용되고 있으며, 갑상선호르몬의 생산 및 분비작용을 억제할 뿐 아니라 면역억제 작용도 있다는 보고도 있다. (Alexander 등, 1973 : Slingerland 등, 1976) Graves 병 치료는 항갑상선제로 조절이 가능하나 영구적 관해율이 바교적 낮기 때문에 일부 환자들은 처음부터 수술이나 방사성 동위원소 치료를 받기도 하는데, 불완전 수술이나 불가변의 갑상선기능저하증이 초래되기도하여 (Dunn등, 1964 : Green 등 1964)초기 치료시는 항갑상선제를 사용하는 추세이다. 그러나 치료기간에 대해서는 많은 논란이 되어왔다.

저자는 1978년 1월부터 1984년 7월까지 연세의대부속 세브란스병원 내과에서 Graves 병으로 진단된 환자 69예를 대상으로 항갑상선제의 치료기간에 따라, 단기군, 중기군, 및 장기군으로 나누어 임상 및 내분비학적 검사로 치료효과를 관찰하여 다음과 같은 결과를 얻었다.

1. 남녀비는 1:6.7로 여자에서 호발하였고 연령은 20∼20대에 가장 많았고 40대, 50대 순이었다.

2. 평균치료기간은 단기군은 3.8±0.4개월 중기군은 8.1±0.2개월, 장기군은 14.8±0.7개월이었다.

3. 투약중단후 재발까지의 기간은 단기군은 0.5∼6.0 (4.1±0.6)개월, 중기군은 1.0∼7.5 (5.2±0.1)개월 장기군은 1.0∼10.0(4.8±0.9)개월로 각군사이에 유의한 차이는 없었다.

4. 관해군의 추적기간은 단기군은 6.0∼32.0(10.7±1.3)개월, 중기군은 9.5∼41.5(11.9±1.1)개월, 장기군은 6.0∼31.0(22.1±2.5)개월이었다.

5. 관해율을 보면 단기군은 28예중 16예로 57.1%였고, 중기군은 21예중 12예로 57.1%였으며, 장기군은 20예중 8예로 40%로써 각군사이에 유의한 차이는 없었다.

6. 관해율은 치료전 갑상선중량이 적을수록, 혈청 T3 치가 낮을수록 높았으며 특히 단기군에서는 재발군보다 관해군이 유의하게 갑상선중량이 적었고, 혈청 T3 치도 낮았다.

7. 혈청 T4치, 혈청 T3/T4비, 항 microsome 항체 및 24시간 갑상선 Ⅰ 섭취율등은 관해율과 상관성이 없었다.

이상의 결과로 치료전 갑상선중량이 적고 혈청T3치가 낮은 경우에는 단기치료로도 좋은 효과를 기대할 수 있을 것으로 사료된다.

A Study on Therapeutic Effect of Antithyroid Agents in Graves' Disease

Mi Hur

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Kap Bum Huh, M.D.)

Although it has been repeatedly noted that Graves' disease may be self-limited,

antithyroid drugs have been used for limited peiods to control the disease. Because

the rate of permanent remission with antithyroid drug was relatively low with

decreased tendency and there is no certain usual means of predicting remission, the

duration of such therapy is arbitrary.

Sixty nine patients with Graves' disease were evaluated clinically and

endocrinologically with grouping of short-term, and long-term at Yonsei University

Severance Hospital during past 7 years.

1. Male to female ratio was 1:6.7 and age distribution was peak in 3rd and 4th

decades.

2. Mean durations of treatment were 3.8±0.4 month in short-term group, 8.1±0.2

months in intermediate-term and 14.8±0.7 months in long-term group.

3. Intervals to relapse were 4.1±0.6 (0.5-6.0) months in short-term group,

5.2±0.1 (1.0-7.5) months in intermediate-term group and 4.8±0.9 (1.0-10.0) months

in long-term group.

4. Follow up periods were 10.7±1.3 (6.0-32.0) months in short-term group,

11.9±1.1 (9.5-41.5) months in intermediate-term group and 22.1±2.5 (6.0-21.0)

months in long-term group.

5. Remission rate was 57.1% in short-term group, 57.1% in intermediate-term group

and 40% in long-term group and was not different with statistical significance in

each group.

6. The thyroid weight was lighter and the serum T3 level was lower in remission

group than in relapse grop in short-term group with statistical significance.

7. Serum T4 level, serum T3/T4 ratio, serum antimicrosomal antimicrosomal titer

and 24 hours I131 uptake rate were not correlated with remission rate.

In conclusion short-term therapy with antithyroid agent in Graves' disease might

be effective in the patients with initial small thyroid size and low serum T3 level

.

[영문]

Although it has been repeatedly noted that Graves' disease may be self-limited, antithyroid drugs have been used for limited peiods to control the disease. Because the rate of permanent remission with antithyroid drug was relatively low with decreased tendency and there is no certain usual means of predicting remission, the

duration of such therapy is arbitrary.

Sixty nine patients with Graves' disease were evaluated clinically and endocrinologically with grouping of short-term, and long-term at Yonsei University Severance Hospital during past 7 years.

1. Male to female ratio was 1:6.7 and age distribution was peak in 3rd and 4th decades.

2. Mean durations of treatment were 3.8±0.4 month in short-term group, 8.1±0.2 months in intermediate-term and 14.8±0.7 months in long-term group.

3. Intervals to relapse were 4.1±0.6 (0.5-6.0) months in short-term group, 5.2±0.1 (1.0-7.5) months in intermediate-term group and 4.8±0.9 (1.0-10.0) months in long-term group.

4. Follow up periods were 10.7±1.3 (6.0-32.0) months in short-term group, 11.9±1.1 (9.5-41.5) months in intermediate-term group and 22.1±2.5 (6.0-21.0) months in long-term group.

5. Remission rate was 57.1% in short-term group, 57.1% in intermediate-term group and 40% in long-term group and was not different with statistical significance in each group.

6. The thyroid weight was lighter and the serum T3 level was lower in remission group than in relapse grop in short-term group with statistical significance.

7. Serum T4 level, serum T3/T4 ratio, serum antimicrosomal antimicrosomal titer and 24 hours I131 uptake rate were not correlated with remission rate.

In conclusion short-term therapy with antithyroid agent in Graves' disease might be effective in the patients with initial small thyroid size and low serum T3 level.