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일차성 점액수종환자에서 차단형 TSH 수용체항체의 유무에 따른 임상상의 차이
이가희(Ka Hee Yi),안종호(Chong Ho Ahn),김원배(Won Bae Kim),정재훈(Jae Hoon Chung),조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),송영기(Young Kee Shong) 대한내과학회 1994 대한내과학회지 Vol.47 No.5
N/A Objectives: To elucidate primary myxedema characterized by progressive atrophy of the thyroid gland and primary hypothyroidism is caused by the blocking type TSH receptor antibody and as a end result of Hashimoto's thyroiditis as well. Methods: We measured thyrotropin-binding inhibitory immunoglobulin (TBII) using radioreceptor assay and thyroid-stimuiation blocking antibody (TSBAb) by bioassay using rat thyroid cell line, FRTL-5, in the sera from 84 patients with primary myxedema and from 61 patients with Hashimoto's thyroiditis and compared their clinical characteristics. Results: Among the patients with primary myxedema THII was detected in 39 patients (46%) and TSBAb in 47 patients (64%). In patients with Hashimoto's thyroiditis, TBII was detected only in 3 patients (5%) and TSBAb in 3 patients (8.8%). The prevalences of both TBII and TSBAb were significantly higher in primary myxedema than those in Hashimoto's thyroiditis. TSBAb activity was significantly higher in TRII positive primary myxedema patients when compared with TBII negative and was positively correlated with TBII activity. The activities of both TBII and TSBAb measured in patients with Hashimoto's thyroiditis were much lower than those in primary myxedema. The mean age at the onset of primary myxedema was significantly lower in the patients with TBII. When compared with the patients with Hashimoto's thyroiditis, mean age at the onset of disease was significantly older in the TBII negative primary myxedema patients. But the age of disease onset in TBII positive myxedema was not different from that of Hashimoto's patients. As the patients were younger at the onset of disease, the prevalence of TBII was higher: for the patients under the age of 29, TBII was detected in 76%, for between 30 and 39, 55%, for 40~49, 45%, for 50~59, 16 % and for over 60, 38 %, respectively (ψ²=24.77, df=l, p<0.05). Among the patients with primary myxedema, 24h 1311-thyroid uptake values were significantly lower in patients with TBII compared to those without TBII (1.5±1.1% vs. 4.1±3.9% p<0.05). Conclusion: These results suggest that primary myxedema may be a heterogenous disease: for the development of hypothyroidism, blocking type TSH receptor antibodies play a major role in one group, especially young patients and cell-mediated destructive mechanisms may be important in another group.