Graves씨병 환자에서 I131 갑상선 주사와 초음파상을 이용한 갑상선 중량 측정에 관한 연구

Abstract

[영문]

[한글]

Graves씨병의 치료방법 중 방사성 동위원소 I**131투여요법을 사용하는 경우, 투여 용

량을 결정하는데 갑상선 중량이 중요하며, 중량 산정방법으로 갑상선 주사를 이용한 Alle

n방법, Spencer방법이 있고, 최근 초음파상을 이용한 Brown방법등이 보고된 바 있으며 이

들의 정확성은 아직도 논란의 대상이 되고있다.

이에 저자는 1978년 1월부터 1983년 9월 91일까지 연세대학교 의과대학부속 세브란스

병원에서 Graves씨병으로 입원하여 갑상선아전절제술을 받은 환자로서 갑상선 주사를 실

시하였던 80예와 갑상선 초음파상을 동시에 시행한 20예를 대상으로 Allen방법, Spencar

방법, Brown방법을 이용하여 각각 계산된 갑상선중량과 실제 중량을 비교하여 다음과 같

은 결과를 얻었다.

1. 대상환자는 남자 17예, 여자 63예 였고(남 : 여 = 1:3.7), 연령은 남자에서 30대 (

평균 33.5세), 여자에선 20대 (평균 28.7세)가 가장 많았다.

2. 갑상선 실제 평균중량은 55.2 21.2g (남자 73.2 26.5, 여자 52.2 19.8) 이었고, 남

자에서 의의있게 더 무거웠다(P＜0.05).

3. Allen방법으로 산정한 갑상선 평균중량은 58.1 2l.1g (남자 74.9 27.5, 여자 53.5 1

8.5)이었고, 실제중량과 비교시 상관계수 0.7의 상관성을 보였고 평균오차 +9.8%였다. 산

정한 평균중량과 실제 평균중량과는 유의한 차이(P＜0.01)를 보여 Allen방법이 실제중량을

완전히 반영한다고 볼 수 없으며, 27예(33.7%)에서 실제중량보다 적게 (평균오차 -15.7%

) 산정 되었다.

4. Spencer방법으로 산정한 갑상선 평균중량은 60.1 25.3g (남자 76.4 23.1, 여자 56.7

21.1)이었고, 실제중량과 비교시 상관계수 0.69의 상관성을 보였으며 평균오차 +16.4%였

다. 산정한 평균중량과 실제 평균중량과는 유의한 차이(P＜0.01)를 보여 Spencer방법이 실

제중량을 완전히 반영한다고는 볼 수 없었으며, 40예(50%)에서 실제중량보다 적게 (평균

오차 -19.1%) 산정 되었다.

5. Brown방법으로 산정한 갑상선 평균중량은 45.1 8.72g (남자 52.9 10.1, 여자 40.5 8

.0)이었고, 실제중량 47.4 9.86g (남자 54.1 11.1, 여자 43.8 9.20)과 비교시 상관계수 0

.7l의 상관성을 보였으며 평균오차 -6.1%였다. 산정한 평균중량과 실제 평균중량과는 유

의한 차이(0.01＜P＜0.05 )를 보여 Brown방법도 실제중량을 완전히 반영한다고는 볼 수 없

었으며, 5예 (25%)에서 실제중량보다 초과(평균오차 +3.4%) 산정 되었다.

이상의 결과로 3방법이 모두 유의한 상관성을 가지나 갑상선 실제중량을 완전히 반영할

수는 없다고 생각되며 Brown방법이 비교적 우수하리라고 생각되나 대상수가 같지 않아

단정할 수 없으며 앞으로 많은 연구가 필요하리라 생각된다.

The study on estimation of the weight of thyroid gland by thyroid radioisotope scan

and ultrasonography in Graves' disease

Kyu Hun Choi

Department of Medical Science The Graduate School Yonsei University

(Directed by Associate Prof. Kap Bum Huh, M.D.)

The thyroid gland weights of 80 patients with Graves' disease were estimated by

Allen's and Spencer's method which were calculation methods by use of radioisotope

I**131 thyroid scan. The thyroid gland Weights of 20 among 80 Patients were

estimated by Brown's method which was calculation method by use of thyroid

ultrasonography. Each methods were evaluated through comparison of estlmated weight

to actual weight, which was measured by subtotal thyroidectomy and results were as

follows;

1. Female to male ratio was 3.7:1. The peak age of incidence was 3rd decade in

female and 4th decade in male.

2. The mean actual thyroid weight was 55.2 21.2g (female 52.2 19.8, male 73.2

26.5). The thyroid weight of male patient was significantly heavier than that of

female patient (P＜0.01).

3. The mean thyroid weight calculated by Allen's method was 58.1 21.1g (female

53.5 18.5, male 74.9 27.5). There was significant correlation between actual

thyroid weight and weight calculated by Allen's method. But there was significant

difference between mean actual thyroid weight and mean weight calculated by Allen's

method (P＜O.01). Mean error was +9.8% and calculated weights of 27 patients were

less than actual weights.

4. The mean thyroid weight calculated by spencer's method was 60.1 25.3g (female

56.7 21.1, male 76.4 23.1). There was significant correlation between actual

thyroid weight and weight calculated by Spencers's method. But there was

significant difference between mean actual thyroid weight and mean weight

calculated by Spencer's method(P＜0.01). Mean error was +l6.4% and calculated

weights of 40 patients were less than actual weights.

5. The mean thyroid weight calculated by Brown's method was 45.1 8.72g (female

40.5 8.0, male 52.9 10.1). There was significant correlation between actual thyroid

weight and weight calculated by Brown's method. But there was significant

difference between mean actual thyroid weight and mean weight calculated by Brown's

method. (0.01＜P＜0.05) Mean error was -6.1% and calculated weights of 5 patients

were mote than actual weights.

In summary, there was significant correlation between thyroid weight calculated

by earth methods and actual thyroid weight. But all methods couldn't represent

actual weight completely. The Brown's method seems to be more accurate than the

other 2 methods by mean error and comparison of mean weight but further studies

will be needed to confirm definitely.