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題名 | Outcome of Antithyroid Medication and Radioiodine Therapy in Pediatric Graves' Disease=兒童期葛瑞夫茲氏症使用抗甲狀腺藥物及放射性碘治療之結果 |
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作者 | 呂淑偉; 遲景上; 徐山靜; Leu, Shu-wei; Chi, Ching-shiang; Shu, San-ging; |
期刊 | 臺灣兒科醫學會雜誌 |
出版日期 | 20030700、20030800 |
卷期 | 44:4 民92.07-08 |
頁次 | 頁220-226+258 |
分類號 | 417.5931 |
語文 | eng |
關鍵詞 | 葛瑞夫茲氏症; 甲狀腺高能症; 抗甲狀腺藥物; 放射性碘; Graves' disease; Hyperthyroidism; Antithyroid medication; Radioiodine; |
中文摘要 | 葛瑞夫茲氏症是造成兒童甲狀腺高能症最常見的原因,可種治療最適於兒童目前仍無定論。此研究的目的在比較不同治療方法之結果及找出可能的預後因子。我們收集了從1990年1月至2002年10月共40位病童,年齡由5.0至17.7歲(平均10.2歲),至少治療1年以上,並分別追蹤了1.1至11.8年(平均5.1年)。這40位病童依不同之治療方法分成3組以比較各別療效。我們也分析藥物治療者在2年內達緩解(7人)及超過2年仍無法緩解(25人)間不同的臨床特徵以找出與治療相關的預後因子。在第1組的28人只接受抗甲狀腺藥物治療(0.7-10年,平均3.4年),有14人(50%)在0.7-6.6年(平均2.6年)後緩解。第2組的9人接受了抗甲狀腺藥物1.1-9.2年仍未緩解後選擇了放射性碘治療((上標 131)I:10-15mCi)),其中8人(89%)在放射性碘治療後1-11個月(平均3.1個月)緩解。第3組的3人以放射性碘((上標 131)I:12-15mCi))爲首選療法,3人(100%)皆在2個月內達緩解。總體而言,接受藥物治療(含第1,2組)的緩解率爲38%(14/37),在放射性碘療法後達緩解的11人中有10人成爲甲狀腺低能狀態而需長期服用甲狀腺素。在分析藥物治療後2年內達緩解者之臨床特徵中,我們未發現貝顯著差異之預後因子,可能與病人數不足有關。我們的結果顯示在較大兒童之葛瑞夫茲氏症以放射性碘爲首選療法或用爲藥物治療後復發者的第二選擇皆是有效的,但治療後有極高比例會成爲甲狀腺低能狀態。 |
英文摘要 | Graves’ disease is a significant medical condition in children. The optimal therapy is controversial. We reviewed 40 pediatric patients with Graves’ disease, 5.0-17.7 yrs of age (mean 10.2 yrs), treated for at least one yr from 1990 to 2002 to assess the outcome of antithyroid medication and radioiodine therapy. The follow-up duration was 1.1-11.8 yrs (mean 5.1 yrs). Clinical variables were also analyzed to identify the prognostic factors. The 40 patients were divided into 3 groups according to their therapeutic options to analyze outcome. To identify predictors, patients who achieved remission after antithyroid drugs within 2 yrs (n=7) were compared with those who received more than 2 yrs of medication but did not enter remission (n=25). In group 1, 28 patients received antithyroid drugs for 0.7-l0 yrs (mean 3.4yrs). Fourteen (50%) achieved remission after 0.7-6.6 yrs (mean 2.6 yrs). In group 2, 9 patients received subsequent radioiodine therapy (10-15 mCi) after antithyroid drugs for 1.1-9.2 yrs (mean 4.4 yrs). Remission was achieved after 1-11 months (mean 3.1 months) in 8(89%). In group 3, initial (superscript 131)I (12-15 mCi) was used in 3 patients. All of them (100%) attained remission within 2 months. The overall remission rate of patients receiving medical therapy (group 1 and 2) was 38% (14/37). Of the 11 patients who achieved remission after radioiodine, 10 had hypothyroid status and required thyroxine replacement. There were no significant differences with any of the clinical variables that might predict remission after medication within 2 yrs, possibly because of the small number of patients. Our data demonstrate that radioiodine is an efficient and effective therapy for pediatric Graves’ disease as first-line treatment or subsequent therapy for those with relapsed disease after medical therapy, although most patients develop hypothyroidism after treatment. |
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