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그레이브스 병에서 항갑상성제 투여중 발생한 갑상성기능저하증의 치료
송기호(Ki Ho Song),김병수(Byung Su Kim),장상아(Sang A Jang),안유배(Yu Bae Ahn),한제호(Je Ho Han),유순집(Soon Jip Yoo),이종민(Jong Min Lee),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),감무일(Moo Il Kang),차봉연(Bong Yun Cha),이광우(Kwang Wo 대한내과학회 1996 대한내과학회지 Vol.51 No.3
N/A Objectives : Antithyroid drug is highly effective and safe in the treatment of Graves` disease. However, some patients may be rendered hypothyroid by large dosage of andithyroid drug : at this point reduction of dosage is common but often difficult to quantitate. Alternatively, combination therapy of antithyroid drug with L-thyroxine is often used, but there are few reports on its long-term effectiveness. Methods : 43 patients with Graves` disease who developed hypothyroidism during methimazole treatment were studied. They received combination therapy of 100mg methimazole with 50 ㎍(group 1, n=16) or 100 ㎍(group 2, n=27) L-thyroxine per day. Hypothyroidism was defined as elevation of seruum thyroid-stimulating hormone (TSH) concentrations above normal ranges. Results : 1) Hypothyroidism occurred within 5.8±3.7(mean ± SD) months after methimazole treatment and mean doses of methimazole were 22,1±8.4mg per day. 2) Serum total thyroxine concentrations increased significantly from 3.7±2,4㎍/dl in the hypothyroid stage to 9.4+3.0 ㎍/dl after 2 months of combination therapy(p<0.0001). 3) Serum TSH concentrations decreased significantly from 34.1+30.6μU/ml in the hypothyroid stage to 3.4+5.2 μU/ml after 2 months of combination therapy(p<0.0001). 4) After 6 months of combination therapy, 74.2Yo of patients became euthyroid. 5) There was no significant difference in the frequency of euthyroid patients after combination therapy betwen group 1 and group 2. Conclusion: These results suggest that long- term combination therapy of antithyroid drug with L-thyroxine in small fixed doses could be effective and convenient to maintain euthyroidism in patients with Graves' disease who developed hypothyroidism during antithyroid drug treatment.
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