한국인 갑상샘 기능 이상 환자에서 갑상샘눈병증의 임상 특징 (The Clinical Characteristics of Thyroid Orbitopathy in Thyroid Dysfunction Patients in Korea)

서지정보

· 발행기관 : 대한안과학회
· 수록지 정보 : 대한안과학회지 / 49권 / 9호 / 1387 ~ 1396페이지
· 저자명 : 우경인, 김윤덕, 이상렬, 안성형연구회

초록

목적: 갑상샘 기능 이상 환자에서 눈병증 정도와 임상양상에 대하여 알고자 하였다.
대상과 방법: 전국 24개 병원 내분비내과에서 갑상샘 기능 이상 환자를 안과의사가 면담하여 설문지를 작성하고 VISA 분류에 의한 눈병증이 있는 환자에 대해 안과검사를 시행하였다. 1986명의 갑상샘 기능 이상 환자 중 눈병증 환자 371명에 대하여 임상양상을 분석하였다.
결과: 주관적 시력저하 10.5%, 염증증상 43.1%, 안구운동장애 15.1%, 외모 및 노출증상을 보인 경우가 86.3% 있었다. 안구돌출이 56.9%, 눈꺼풀후퇴 31.5%, 외안근 이상 15.1%, 시신경 이상은 2.4% 있었다. 눈병증군의 안구돌출계 중간값은 16 mm, 안구돌출 환자의 중간값은 17 mm였다. 눈증상에 대한 주관적 평가지수는 시작 보다 많이 호전되었다고 한 경우 12.1%, 호전 19.5%, 변화 없음 51.2%, 악화 19.6%, 많이 악화된 경우가 1.0% 있었다.
결론: 갑상샘 기능 이상 환자 중 많은 수에서 갑상샘눈병증이 있었다. 활동성 염증을 보이는 눈병증 환자들을 보다 적극적으로 안과검사를 하도록 권유하고 치료하여 눈증상을 완화시키고 후유증을 최소화 하여야 하겠다.

영어초록

urpose: To investigate the clinical manifestation of thyroid orbitopathy among patients with thyroid dysfunction.
Methods: A cross-sectional study was conducted at 24 general hospitals in Korea. All dysthyroid patients who visited the endocrinology clinic for 1 week were included. Data were collected during an interviewer- administered questionnaire. Thyroid orbitopathy was diagnosed in cases with relevant symptoms according to the VISA classification for which an eye examination was performed. Three hundred seventy-one patients who had thyroid orbitopathy out of 1986 dysthyroid patients were evaluated.
Results: Vision symptoms were presented in 10.5% of thyroid orbitopathy patients, inflammation symptoms in 43.1%, strabismus in 15.1%, and appearance and exposure symptoms in 86.3% of patients. Among the eye symptoms, proptosis was most prevalent in 56.9% of patients followed by eyelid retraction in 31.5%, diplopia in 15.1% and optic nerve dysfunction in 2.4% of patients. Median value of exophthalmometry in the thyroid orbitopathy group was 16 mm and 17 mm in the proptosis group. Patient self assessment for thyroid orbitopathy from the onset of the disease was "greatly improved" in 12.1% of patients, "improved" in 19.5%, "unchanged" in 51.2%, "worse" in 19.6%, and "much worse" in 1.0% of patients.
Conclusions: Among dysthyroid patients, significant amount was found to have symptoms related with thyroid orbitopathy. The patients with thyroid orbitopathy, except for the mildest cases, need to be managed by a thyroid eye disease specialist for further assessment and care.

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