葛瑞夫茲氏病的治療

Treatment of Graves' Disease

邱耀興(Yao-Hsing Chiu) ； 婁培人(Pei-Jen Lou) ； 王守仁(Shou-Jen Wang) ； 蘇景傑(Ching-Chieh Su) ； 陳正文(Jeng-Wen Chen)

《台灣耳鼻喉頭頸外科雜誌》 42卷3期 (2007/06) Pp. 90-95

https://doi.org/10.6286/2007.42.3.90

摘要

葛瑞夫茲氏病(Graves' disease)為一自體免疫疾病，病患體內因產生近似甲狀腺刺激素(thyroid stimulating hormone, TSH)的抗體刺激甲狀腺，而出現甲狀腺機能亢進(hyperthyroidism)及甲狀腺腫(goiter)等相關症狀。葛瑞夫茲氏病的主要治療方式包括內科療法、放射性碘治療及手術治療等。自上世紀中嘗試以手術治療葛瑞夫茲氏病以來，保留少部分甲狀腺組織之甲狀腺次全切除(subtotal thyroidectomy)是普遍被接受的術式，近年來卻有許多學者建議以甲狀腺全切除(total thyroidectomy)取而代之。本文報告一名24歲之葛瑞夫茲氏病女性患者，因巨大甲狀腺腫(goiter)影響外觀且藥物控制效果不佳而接受甲狀腺右葉全切除併左葉次全切除，同時回顧整理近期文獻，重新審視比較各項術式之優劣。

關鍵字

葛瑞夫茲氏病 ； 甲狀腺機能亢進 ； 甲狀腺次全切除 ； 甲狀腺全切除

並列摘要

Graves' disease is an autoimmune disorder characterized by hyperthyroidism and diffuse goiter. The disease is caused by stimulation of the thyroid by TSH receptor antibodies. The available treatments for Graves' disease includes antithyroid drugs, radioiodine therapy, and surgical treatment. Since the early 20th century, subtotal thyroidectomy has been the standard surgical treatment used with Graves' disease. However, some surgeons have recently begun to recommend total thyroidectomy rather than subtotal thyroidectomy as the preferred surgical treatment for Graves' disease. We present here a 24-year-old female with Graves' disease who received a unilateral total thyroid lobectomy with contralateral subtotal thyroid lobectomy. This treatment was chosen due to the presence of a huge goiter and to poor medical control results. The literature on Graves' disease is reviewed in order to assess the advantages and disadvantages of the various possible approaches to surgical management.

並列關鍵字

Graves' disease ； hyperthyroidism ； subtotal thyroidectomy ； total thyroidectomy