: (h y perth y roidis m ) (th y rotox icos is ),.,,,,, (g oiter) (trachea) 1). 80% 93% (m y opathy ) 6). 2).. (T otal lun g capacity, T LC)

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1 : (h y perth y roidis m ) (th y rotox icos is ),.,,,,, (g oiter) (trachea) 1). 80% 93% (m y opathy ) 6). 2).. (T otal lun g capacity, T LC), (Res idu al v olum e, RV ), (V ital capacity, V C).,., : : , (thy roid stim u latin g h orm on e, T S H ),.,, 22 ( 6, 7, 1 8 )., T ab le ) triiodoth y ron in e(t 3) (A b ott, N orth Chicag o, IL), thy rox in e(free T 4) 2 (Gam m acoat F ree T 4 RIA k it, Clin ical A s s ay, In cstar, S tillw ater, M N ), T S H (A b bott, N orth Chicag o, IL). ( ) T S H 710

2 W on B a e K im, e t a l : Ch a n g es in pu lm on a ry v en t ila t or y fu nc t ion in pa t ien t s w ith t h y r ot ox ic os is T able 1. Clinic al c harac te ris tic s o f enrolle d s ubje cts C on t rol (n =22) T h y r ot ox icos is (n =32) p v a lu e A g e (y e a r s ) (r a n g e) S e x ( M :F ) 1 : 21 S e ru m T 3 (n g / d l) S e ru m fr ee T 4 (n g / d l) S e ru m T S H (IU / L ) v a lu e s a re m ea n S.D., ; n ot s ig n ifica n t : T 3 T 4. T n g / dl, T n g / dl, T S H IU/ m l. 2) S en s orm edics 2200 pulm on ary fu n c tion laboratory (S en sorm edics, Yorb a Linda, CA ) (F orced v ital capacity, F V C), 1 (F orced ex piratory v olu m e for 1 sec., F E V 1.0), F E V 1.0/ F V C (F orced ex piratory flow 25 75, F E F 25 75, F orced ex piratory flow 50, F E F 50). (diffus in g capacity, DLCO) (DLCO/ V a). 2 6 T 4 T 3, 3. S pirom etry 80%, 65 80%, 50 65%, 50%. 3) (th y rotropin bin din g in h ibitor im m un og lobu lin, T BII), T S H (R S R, Cardiff, U K ). 50 u l 1% lub rol I b T S H m M T ris / 50 m M N acl/ 0.1% BS A (ph 7.4) 1 m l 30% P E G (1500 g, 30 m in., 4 ). 1% lu brol (non s pecific bin din g ). T BII (% ) 125I b T S H T S H ( ) 15%. (antim icrosomal antibody, AMA) (antithy rog lobulin an tibody, A T A ) (R S R, Cardiff, U K ) (R adioreceptor ass ay ). A M A A T A 0.3 U/ m l. 4). s tu den t' s t tes t, s tu den t' s paired t tes t. P ears on. p

3 대한내과학회지 : 제 56 권 제 6 호 통권 제 466 호 1999 T a b le 2. C o m pa ris o n o f s p iro m e t ric pa ra m e te rs b e t w e e n pre t re a t m e n t t h y ro to x ic pa tie n ts a n d c o n t ro l FVC C on t r ol (n =22) T h y r otox icos is ( n =32) 3.35± ± ±12 82± ± ± ±12 90±18 84±8 88±8 3.16± ± ±24 97±27 ( L) ( % p r ed ic te d ) F E V 1.0 ( L) ( % p r ed ic te d ) F E V 1.0/ F V C (% ) F E F ( L/ s e c) ( % pr ed ic te d ) p v a lu e v a lu e s a r e m ea n ±S.D. F V C ; for ce d v ita l c a p a cit y, F E V 1.0; for c ed e x p ir a t ory v olu m e for 1 s ec., F E F ; forc ed ex pir a t or y flow, ; n ot s ig n ifica n t F ig. 1. C om pa r is on of p er c en t p re d ict ed v a lu es for for ce d v it a l ca pa c ity ( F V C ) b et w ee n t h y rot ox ic os is p a t ien ts a n d c on t r ol. F ig. 2. C om pa r is on of F E V 1.0/ F V C b et w e en t h y r ot ox icos is pa tie n t s a n d c on t rol. 과는 T a b le 2와 같다. F V C 는 환자군에서 3.06±0.68 L, 소되어 있었다( p, T a b le 2, F ig 1). F E V 1.0, F E F 대조군에서 3.35±0.55 L 이었고, 성별 및 신장으로 보정 25 75, F E F 50 등의 지표는 환자군과 대조군 간에 차이 한 정상 예측치에 대한 비율(% p red ict ed v a lu e of F V C ) 가 없었으며 F E V 1.0/ F V C 는 환자군에서 88±8 % 로 대조 은 각각 82±16 %, 95±11 % 로 환자군에서 유의하게 감 군의 84±8 % 에 비하여 유의하게 증가되어 있었다 T a b le 3. C o m p a ris o n o f a lv e o la r d iff u s in g c a p a c it y b e t w e e n th y ro t o x ic p a t ie n t s a n d c o n tro l C on t r o l ( n = 22 ) D L CO ( m l/ m in / m m H g ) ( % p r e d ic t e d ) D L CO/ V a ( 1 / m in / m m H g ) ( % p r e d ic t e d ) T h y r o t o x ic o s is ( n = 32) p v a lu e 22.4± ± ± ± ± ± 16 v a lu e s a r e m e a n ± S.D., ; n o t s ig n ific a n t ± ± 17

4 김원배 외 7인 : 갑상선중독증 환자에서 폐환기 기능의 변화 T a b le 4. C o rre la t io n b e t w e e n t h y ro id fu n c tio n pa ra m e te rs o r T B II a c t iv itie s a n d pu lm o n a ry f u n c tio n pa ra m e te rs in p re tre a t m e n t th y ro t o x ic p a tie n t s. S er u m T 3 S e r u m fr e e T 4 T B II a c t iv it y FVC * F E V * F E V 1.0 / F V C F E F D L CO D L CO / V a V a lu e s a r e P e a r s on c o r r e la t io n c o e ffic ie n t s. T B II; t h y r o t r o p in b in d in g in h ib it o r im m u n o g lo b u lin, F V C ; fo r c e d v o lu m e fo r 1 s e c., F E F ; fo r c e d e x p ir a t or y flo w * ; p, ' ' ; n o t s ig n ific a n t (p, T a b le 2, F ig 2). D L CO, 폐포용적으로 교정한 D L CO ( D L CO/ V a)는 환자군 및 대조군 간에 차이가 없었 v it a l c a p a c it y, F E V 1.0; for c e d e x p ir a t o r y 2. 갑상선중독증 환자에서 치료 전후의 폐환기 기 능의 변화 다( T ab le 3). 환자군에서 갑상선기능검사 지표들 및 갑상선 자가항 갑상선중독증 환자들 중 항갑상선제 복용후 정상 갑 체 역가와 치료전 폐기능검사 지표 간의 상관관계를 분 상선호르몬혈증으로 된 18예를 대상으로 치료전후의 폐 석한 결과 혈청 T B II 활성은 F V C( R = 0.45, p) 및 기능검사 지표를 비교한 바 이는 T a b le 5에 나타내었다. F E V 1.0( R = 0.41, p)과 유의한 음의 상관관계를 보 F V C, F E V 1.0은 치료전에 비하여 치료후 유의하게 증 였으며 혈청 총 T 3, 유리 T 4 농도는 이들 지표와 유의한 가하였고 F E V 1.0/ F V C 는 치료후 유의하게 감소하였다. 상관관계가 없었다( T ab le 4). 치료 전후에 폐기능검사를 시행하였던 18명의 환자에서 폐기능검사 결과의 판정은 F ig. 3과 같다. 즉, 폐환기 기 능검사상 정상, 경도의 제한성 장애, 중등도의 제한성 장 애 및 고도의 제한성 장애를 보인 환자는 치료전 10, 4, F ig. 4. C orr e la t ion b e tw ee n c h a n g es in for c ed v it a l c a p a c it y (ΔF V C ) a n d c h a n g es in c on c en t ra t ion of s er u m T 3(ΔT 3) a fte r tr e a t m e n t of p a t ien ts w ith th y rot ox ic os is. F ig. 3. C h a n g e s in c a t eg orie s of v e n t ila tor y d y s fu n c t ion a ft er a n t it h y r oid d ru g tr e a t m e n t in t h y r otox icos is pa tie n t s. 71 3

5 K ore a n Jou rn a l of M e dic in e : V ol. 56, N o. 5, 1999 T able 5. Chan g es in pulm o na ry fun ction param e te rs afte r antith y roid drug treatm en t in thy ro to x ic pa tie nts ( n=18) B efor e t re a t m en t A ft er tr ea tm en t p v a lu e F V C (L ) F E V 1.0 (L ) (% p re d ic te d ) (% p re d ic te d ) F E V 1.0/ F V C(% pr ed ict ed ) F E F (L / s ec ) (% p re d ic te d ) D L CO (m l/ m in / m m H g ) (% p re d ic te d ) D L CO/ V a (1/ m in / m m H g ) (% pr ed ic te d ) v a lu e s a re m ea n S.D. F V C ; for ce d v ita l c a p a c ity, F E V 1.0; for ce d ex pira tory v olu m e for 1 s ec., F E F ; forc ed e x p ira tory flow, ; n ot s ig n ifica n t , 1 14, 2, 2, 0., F E F 25 75, DLCO, DLCO/ V a. F V C. T 4 ( ft 4), T 3 ( T 3) F V C ( F V C), T 3 F V C (R= 0.47, p, F ig. 4).,,,,, 1)...,,.,. (3 cm ). (F V C)., 25). 80% 90% 6). (thy rotox ic m y opathy ), (peak inspiratory pressure) (peak ex piratory 714

6 W on B a e K im, e t a l : Ch a n g es in pu lm on a ry v en t ila t or y fu nc t ion in pa t ien t s w ith t h y r ot ox ic os is press u re)., F V C. 4, 68)... F V C T B II...,,,,. (ex traocu lar m u scle) 9, 10)..... T 3 F V C. 45%. 1/ 2.,. F E V 1.0/ F V C, F E V 1.0/ F V C 4, 5), 11, 12). F E V 1.0 F E V 1.0. F E V 1.0 F V C., F E V 1.0/ F V C F E V 1.0/ F V C F E V F V C T 3 T 4., T 4 T 3 5' (5 deiodin ase) 13). 5' T 3 T 4 ( T 4 T 3 ),, T 3., T 4 T 3 F V C F V C. 715

7 : (F V C) T B II. :... : ,, 22, 18. : 1) F V C L, L, (% predicted v alu e of F V C) %, % (p). 2) F E V 1.0, F E F 25 75, F E F 50, F E V 1.0/ F V C 88 8 % 84 8 % (p). 3) T BII F V C(R= 0.45, p) F E V 1.0(R= 0.41, p) T 3, T 4. 4) F V C, F E V 1.0 F E V 1.0/ F V C.,, 10, 4, 3, 1 14, 2, 2, 0. : (F V C), 45 %.., F V C. = A b s t r a c t = C h a n g e s i n p u lm o n a ry v e n t i la t o ry f u n c t io n i n p a t i e n t s w i t h t h y ro t o x ic o s i s W on B a e K im, M.D., H y u n K y u n g C h u n g, M.D. S u n H w a L e e, M.D., B y u n g S ool M oon, M.D. J a e H o L e e, M.D., D o J oon P a r k, M.D. B o Y ou n C h o, M.D. a nd H e e S oon C h u n g, M.D. D e partm e nt of I nte rnal M e d icine, S e ou l N ational U niv e rsity Colle g e of M e d icine, S e oul, K ore a Objectiv e : Dyspnea is a comm on sym ptom in pa tients w ith thy rotox icos is, w hich m a y b e ca us ed by sev era l m ech an ism s includin g pu lm ona ry v entilatory dy s fun ction. T here ha v e been con trov ers ies a m on g studies on ch an g es in pu lm ona ry v entilatory fu nction in thy rotox icos is. W e w ere to ev a lua te the chan g es in pu lm ona ry v en tila tory function in pa tien ts w ith thy rotox icosis. M ethods : W e m ea s ured the pulm on ary v en tila tory function w ith s pirom etry in 32 th yrotox ic pa tients w ith Grav es ' dis ea s e an d in 22 a g e, s ex m atch ed eu th y roid con trol s ubjects. T he chan g es in v en tilatory fun ction a fter treatm ent w ere ev a lua ted in 18 th y rotox ic pa tien ts w ho beca m e euthy roid w ith an tithy roid drug treatm en t. Re s ults : 1) F orced v ita l capa city (F V C) w a s s ig n ifican tly low er in th y rotox ic patien ts com pared to control su bjects ( L a nd L, res pectiv ely, p). P ercent predicted v alues of F V C show ed s im ila r resu lts ;

8 7 : % in patien ts a nd % in control su bjects (p). 2) F orced ex piratory v olum e for 1 sec.(f E V 1.0), forced ex pira tory flow 25 75(F E F 25 75) an d F EF 50 w ere not different betw een pa tients an d control s ubjects. F EV 1.0/ F V C ratio w ere h ig her in th y rotox ic pa tient th an in con trol(88 7 % v s %, p). 3) S erum thy rotropin bindin g inh ibitor im m un og lobulin (T BII) activ ities w ere s ig n ifican tly correla ted w ith pretrea tm en t F V C v a lues(r= 0.45, p) an d w ith F EV 1.0 v alu es (R= 0.41, p) in thy rotox ic pa tients. H ow ev er, s eru m thy roid horm one con cen tra tions h ad no correla tion s w ith F V C or w ith F E V 1.0 v a lues. 4) F V C, F EV 1.0 of thy rotox ic pa tients increa sed, an d F EV 1.0/ F V C ratio decreas ed s ifnifica n tly a fter trea tm en t of th y rotox icosis in pa tient g roup. N u m bers of pa tients w ith n orm al, m ild, m odera te, sev ere restrictiv e diseas e w ere 10, 4, 3, 1, res pectiv ely before treatm ent, w h ich beca m e 14, 2, 2, 0 a fter treatm ent of thy rotox icos is in pa tient g rou p. Con clus ion : V entilatory dis turban ces of restrictiv e pa ttern w ere com m on in thy rotox ic pa tients tha t w ere pa rtia lly rev ersible a fter trea tm ent of th yrotox icos is. S uch ch an g es m a y be one of m echa n is m s ca us ing dy spnea in th y rotox ic pa tien ts. T h e fact that decreas e in F V C w ere sig nifican tly as s ocia ted w ith seru m T BII activ ities (thy roid a utoan tibody ), bu t n ot w ith deg ree of thy rotoxicosis sug gests that autoimm une process itself is in v olv ed in the dev elopm ent of pu lm ona ry fun ction a bnorm a lities observ ed in th ose pa tien ts. Ke y W o rds : T hy rotox icosis, pu lm ona ry fun ction test, forced v ital ca pa city (F V C) R E F E R E N C E S 1) In g ba r DH : T he re sp iratory sy ste m in thy rotox icosis. I n : B rav e rm an L E, U tig e r R B, e d s, T he T hy roid, 7th E d., p , L ip pincott R av e n P re ss, P hilad e lp hia, ) P eaboy F, W entw orth J: C linical stud ie s of the re spiration. T he v ital cap acity of lu ng and its re lation to d y sp ne a. A rch I nte rn M e d 20:443, ) Rabin ow itch I: T he v ital capacity in hy p e rthy roid ism with a stu d y of the influe nce of p osture. A rch I nte rn M e d 31:910, ) M ier A, Brophy C, W a ss JA H, Bess er GM, Green M : R e v e rsible re sp iratory m u scle we ak ne ss in hy pe rthy roid ism. A m R e v R e sp ir D is 139:529, ) S iafak as N M, M ilona I, S a les iotou V, F iladita ki V, T za n akis N, Bouros D: R e sp iratory m uscle stre ng th in hy p e rthy roid ism be fore and afte r tre atm e nt. A m R e v R e sp ir D is 146:1025, ) Ram sa y I: T hy rotoxic m uscle d ise ase. P ostg rad uate M e d J 44:385, ) A y res J, Rees J, Clark T JH, M a is ey M N : T hy rotox icosis and d y spne a. C lin E nd ocrinol 16:65, ) F reedm an S : L u ng v olum e s and d iste nsibility and m axim um re sp iratory pre sssure s in thy roid dise ase be fore and afte r tre atm e nt. T horax 33:785, ) W eetm an A P : T hy roid associate d op hthalm op athy. A utoim m u nity 12:215, ) Dy er JA : T he oculorotatory m us cle s in G rav e s' d ise ase. T rans A m O p hthalm ol S oc 74:425, ) M celv a ney GN, W ilcox P G, F a irbran M S : R e spiratory m uscle we ak ne ss and d y sp ne a in thy rotox ic p atie nts. A m R e v R e sp ir D is 141:1221, ) S tein M, K im bel P, John s on R: P ulm onary function in hy pe rthy roid ism. J Clin I nv e st 40:348, ) Chopra IJ: A stud y of e x trathy roid al conv e rsion of thy rox ine to 3,5,3' T riiod o L thy ronine in the rat. J C lin Inv e st 50:1124,

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