頁籤選單縮合
題名 | Clinical and Laboratory Findings at Initial Diagnosis in Pediatric Graves' Disease in Taiwan=臺灣葛瑞夫茲氏病兒童初發病時的臨床及實驗室檢驗表現 |
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作者姓名(中文) | 洪嘉穗; 張鑾英; 許薰惠; 趙婷; 范揚灝; 羅福松; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 47:2 民95.03-04 |
頁次 | 頁77-82+107 |
分類號 | 417.5931 |
關鍵詞 | 葛瑞夫茲氏病; 甲狀腺高能症; 兒童; 青少年; Graves' disease; Hyperthyroidism; Childhood; Adolescent; |
語文 | 英文(English) |
中文摘要 | 我們分析從1995至2005年在台灣長庚兒童醫院剛發病的106位葛瑞夫茲氏病兒童的臨床症狀及實驗數據。最小發病年齡為3.36歲,隨著兒童時期年齡增加而增加,15歲是高峰。46位(48%)有甲狀腺疾病家族史。我們依照青春期發育程度把病童分為以下三組:青春期前期(Tanner第1級),34人(佔32%);青春期中期(Tanner第2至級),13人(佔12%);青春期後期(Tanner第5級),59人(佔56%)。最常見的臨床表現為瀰漫性甲狀腺腫、怕熱、容易流汗、心悸、食慾增加卻體重下降,但三組間未達統計差異。神經心理症狀如神經質、過動、學校表現差是病童的常見特色。身高標準誤差分數(0.33±1.35)顯示身高偏高(青春期前期為0.39±1.66、青春期中期為-0.066±0.63,青春期後期為0.40±1.23)。骨骼成熟度在所有三組也是超前(骨齡/實際年齡比1.09±0.22、1.07±0.20、1.08±0.08),但三組間未達統計差異。身體質量指數(標準誤差分數)在所有三組是偏低(-0.49±1.10,-0.68±0.63,and -0.13±0.98),但三組間未達統計差異。心跳快(96%)、甲狀腺腫(94%)、細微顫動(92%)、甲狀腺雜音(66%)、高血壓(63%)、凸眼(60%)為常見的症狀。實驗數據發現血清驗不出TSH的濃度(<0.03μIU/mL)、FT4(5.54±2.26ng/dL)升高、TT4(18.37±4.79μg/dL)升高、TT3(450.4±202.2ng/dL)升高,但三組間未達統計差異;TBII、AMCA、TGAB的陽性率各別為96%、95%、71%。結論是我們並無法發現青春期前期、青春期中期及青春期後期葛瑞夫茲氏病患間在疾病表現上有顯著差異;葛瑞夫茲氏病症狀的深入了解對於提早診斷及處理是不可或缺的,因為它可以嚴重干擾兒童的生長及發育。 |
英文摘要 | We analyzed the clinical and laboratory data of 106 children (17 boys and 89 girls, 11.7±3.4 years old) with newly diagnosed Graves' disease at Chang-Gung Children's Hospital in Taiwan from 1995 to 2005. The earliest age of disease onset was 3.36 years old, and incidence progressively increased throughout childhood, with a peak at 15 years old. Forty-six (48%) of 95 children had a positive family history of thyroid disorders. We divided the children into three groups according to pubertal stage: prepubertal (Tanner stage 1), 34 (32%); pubertal (Tanner stage 2-4), 13 (12%); and postpubertal (Tanner stage 5), 59 (56%). The most common presentations were diffuse goiter, heat intolerance, sweating, palpitations, and weight loss despite an increase in appetite, but there were no significant differences among the three groups. Neuropsychiatric symptoms such as nervousness, hyperactivity and poor school performance are common features in these children. Height standard deviation score (0.33±1.35) revealed tall stature (0.39±1.66 in the prepubertal group, -0.066±0.63 in the pubertal group. and 0.40±1.23 in the postpubertal group). Bone maturation also was accelerated in all three groups (bone age/chronological age 1.09±0.22, 1.07±0.20, and 1.08±0.08), but there were no significant differences between groups. Body mass index (standard deviation score) was low in all three groups (-0.49±1.10, -0.68±0.63, and -0.13±0.98), with no significant differences between groups. Tachycardia (96%), goiter (94%), fine tremor (92%), bruit (66%), hypertension (63%), and exophthalmos (60%) were the most frequent symptoms. Laboratory findings yielded undetectable TSH levels (<0.03μIU/mL), increased FT4 (5.54±2.26ng/dL), TT4 (18.37±4.79μg/dL), and TT3 (450.4±202.2ng/dL), with no significant differences between groups. The prevalences of positive TBII, AMCA, and TGAB were 96%, 95%, and 71% respectively. In conclusion, we did not find any differences in the presentation of Graves' disease among prepubertal, pubertal, and postpubertal patients. An awareness of symptoms is necessary for prompt diagnosis and management of Graves' disease because the disease can seriously interfere with children's growth and development. |
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