Sugino Kiminori, Ito Koichi, Mimura Takashi, Fukunari Nobuhiro, Nagahama Mitsuji, Ito Kunihiko
Surgical Branch, Ito Hospital, Tokyo, Japan.
Thyroid. 2004 Jun;14(6):447-52. doi: 10.1089/105072504323150769.
Thyroidectomy may be indicated in children with Graves' disease who have adverse reactions to antithyroid drugs or who relapse after antithyroid drug therapy. We investigated the characteristics of childhood Graves' disease from the standpoint of surgical outcome. Between 1989 and 1998, 1897 patients with Graves' disease underwent thyroidectomy and their thyroid function could be evaluated 2 to 3 years after thyroidectomy. The patients were divided into three groups according to age at thyroidectomy: 74 patients were 15 years old or less (children), 345 patients 16 to 20 years of age (adolescents), and 1478 patients 21 years of age or more (adults). The children included higher proportions of patients who had a large goiter (> 100 g), high thyrotropin-binding inhibitory immunoglobulin (TBII) level (> 50%), and small remnant thyroid (< 4 g). At 2 to 3 years after thyroidectomy, the overt recurrence rate of the children, adolescents, and adults was 9.5%, 4.9%, and 5%, respectively. The cumulative recurrence-free rate of the children, adolescents, and adults at 5 years after thyroidectomy was 82%, 90%, and 92%, respectively. Surgical complications were more frequently observed in children. Considering the aggressiveness of childhood Graves' disease, subtotal thyroidectomy with thyroid remnant less than 3 g is the procedure of choice for preventing recurrent hyperthyroidism.
对于患有格雷夫斯病且对抗甲状腺药物有不良反应或抗甲状腺药物治疗后复发的儿童，可能需要进行甲状腺切除术。我们从手术结果的角度研究了儿童格雷夫斯病的特征。1989年至1998年期间，1897例格雷夫斯病患者接受了甲状腺切除术，术后2至3年可评估其甲状腺功能。根据甲状腺切除时的年龄将患者分为三组：74例患者年龄在15岁及以下（儿童），345例患者年龄在16至20岁（青少年），1478例患者年龄在21岁及以上（成人）。儿童组中甲状腺肿大较大（>100g）、促甲状腺素结合抑制性免疫球蛋白（TBII）水平较高（>50%）以及残余甲状腺较小（<4g）的患者比例更高。甲状腺切除术后2至3年，儿童、青少年和成人的明显复发率分别为9.5%、4.9%和5%。甲状腺切除术后5年，儿童、青少年和成人的累积无复发率分别为82%、90%和92%。儿童中手术并发症的观察更为频繁。考虑到儿童格雷夫斯病的侵袭性，甲状腺残余小于3g的次全甲状腺切除术是预防复发性甲状腺功能亢进的首选手术方式。
