台灣地區甲狀腺機能亢進治療型態之探討

A Study on Hyperthyroidism Treatment Patterns in Taiwan

李帶琪(Tai-Chi Lee)

指導教授 ： 林瑞雄

國立臺灣大學/公共衛生學院/預防醫學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.10229

摘要

本研究目的是以分析臺灣接受甲狀腺機能亢進症治療者的資料，了解其年齡、性別等的差異；分析醫師對甲狀腺機能亢進症的臨床處理方式及與國際臨床治療指引比較。本研究以國衛院提供之「全民健保研究資料庫」 的次級資料，分析1997年至2004年的全民健康保險資料庫承保抽樣歸人檔資料中，甲狀腺機能亢進患者在診療人數及處方檢驗上的耗用情形。以1997年至1999年為研究資料清洗期間，未在此期間內發生接受甲狀腺機能亢進治療的病患才歸屬於新發病個案研究。在2000年1月1日至2004年12月31日共有1157位新發病個案，接受口服抗甲狀腺藥物治療者共有949人（82%），是臺灣常見的第一線治療方式。第一次發病即接受手術者有202人（17.5%），第一次發病接受放射碘治療者只有6人（佔0.5%）。因甲狀腺機能亢進接受治療的年齡層高峰，女性為51~60歲，男性為31~40歲和71~80歲，甲狀腺機能亢進在高齡族群仍是重要的疾病。接受治療之甲狀腺機能亢進的年發生率在1.2‰〜1.4‰之間，女性為每年2.02‰，男性為每年0.58‰，女性比男性約為3.5:1。接受非口服藥治療的相關因子為年齡、性別。以口服抗甲狀腺藥物治療之甲狀腺機能亢進新個案，累積治療天數，女性平均治療天數為286.5天，男性平均治療天數為288.5天。具有抗甲狀腺藥物療程的729名甲狀腺機能亢進新個案，停藥後42.6%（311人）在追蹤期間內產生甲狀腺機能亢進復發，緩觧曲線數據分析可知抗甲狀腺藥物治療的平均復發時間為958天，約為2.6年，而有50%的甲狀腺機能亢進患者接受抗甲狀腺藥物治療停藥後833天（2.28年）會復發。與國際臨床診療指引相比較，有48.2%的病人 (265/549)是在開始治療後的 1〜3個月內第一次追蹤檢驗甲狀腺功能，屬於適當監測血清甲狀腺功能，適當監測血清甲狀腺功能的相關因子為年齡、地區、醫療院所層級。與國際臨床診療指引相比較，15.7%以抗甲狀腺藥物作為第一次治療甲狀腺機能亢進的病人，符合國際臨床診療指引所建議的用藥期間。適當口服抗甲狀腺藥物治療期間與年齡、地區、監測血清甲狀腺功能適當與否有關。以抗甲狀腺藥物作為第一次治療甲狀腺機能亢進的病人，有64.5%治療累積天數少於9個月，與國際臨床診療指引所建議的用藥期間短少許多；臺灣甲狀腺機能亢進患者抗甲狀腺藥物的最適治療期間，仍待進一步研究。

關鍵字

全民健保 ； 甲狀腺機能亢進 ； 流行病學 ； 治療型態 ； 醫療利用 ； 臺灣

並列摘要

This study was intended to explore the treatment and follow-up patterns of hyperthyroidism in Taiwan and compared with guideline standards.Claims data of hyperthyroidism cases of the National Health Research Institute were collected as the data base for analysis during the period 1997 to 2004. The washout duration of new incident treated as hyperthyroidism was 3 years. The subjects who had received anti-thyroid drugs or radioiodine or thyroid operation with the principle diagnosis of hyperthyroidism as the initial treatment of hyperthyroidism between 2000 and 2004 were included in our research. In total, there were 1151 new incident treated hyperthyroidism.
The annual incidence was 1.2‰ to 1.4‰ from 2000 to 2004. The female incidence was 2.02‰ and male incidence was 0.58‰. Respectively sex ratio was 3.5 : 1. The peak age was 51 to 60 y/o in female and 31-40 y/o and 71-80 y/o in male. Hyperthyroidism was not a rare disease in aged population.
There were 949 subjects (82%) received antithyroid drug as the first line therapy;202 subjects (17.5%) received thyroid operation as the first line therapy; only 6 subjects (0.5%) received radioiodine as the first line therapy.
The mean treatment duration with antithyroid drug was 286.5 days in female and 288.5 days in male. Relapse occurred in 42.6% patients during the follow-up period after drug withdraw. Remission analysis revealed that the mean relapse time was 2.6 years and median relapse time was 2.28 years. Compared with the internation treatment guideline , appropriate thyroid function monitoring after medication was found in 48.2% patients and appropriate antithyroid drug treatment duration was found only in 15.7% patients.
The factors associated with appropriate thyroid function follow-up were patient’s age、geographic area and hospital types. The related variables to appropriate medication were patient’s age and proper thyroid function monitor.

並列關鍵字

National Health Insurance ； Hyperthyroidism ； Treatment Patterns ； Epidemiology ； Health Care Utilization ； Taiwan

參考文獻

Leu, S. W., C. S. Chi, et al. (2003). "Outcome of Antithyroid Medication and Radioiodine Therapy in Pediatric Graves' Disease." Acta Paediatr Tw 44(4): 220-226.

陳美州, 何弘能, et al. (2001). 婦產科：甲狀腺疾病與婦女生殖. Obstetrics and Gynecology: Thyroid Disease and Female Reproduction, 臺灣醫學會: 3.

Chen, Y. L., T. C. Chang, et al. (1994). "I nfluence of smoking on Graves' disease with or without ophthalmopathy and nontoxic nodular goiter in Taiwan." J Formo Med Assoc 93(1): 40-44.

林美慧, 蔡文友, et al. (1988). Hyperthyroidism in children. 兒童甲狀腺機能亢進症, 臺灣兒科醫學會: 8.

(2002). "American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism." Endocr Pract 8(6): 457-69.