[갑상샘 중독증 (Thyrotoxicosis)의 원인 분류]

TABLE 396-1 Causes of Thyrotoxicosis
Primary Hyperthyroidism
Graves’ disease
Toxic multinodular goiter
Toxic adenoma
Functioning thyroid carcinoma metastases
Activating mutation of the TSH receptor
Activating mutation of Gsα (McCune-Albright syndrome)
Struma ovarii
Drugs: iodine excess (Jod-Basedow phenomenon)
Thyrotoxicosis without Hyperthyroidism
Subacute thyroiditis
Silent thyroiditis
Other causes of thyroid destruction: drugs (amiodarone, cytokines, tyrosine kinase inhibitors, immune checkpoint inhibitors), radiation, infarction of adenoma
Ingestion of excess thyroid hormone (thyrotoxicosis factitia) or thyroid tissue
Secondary Hyperthyroidism
TSH-secreting pituitary adenoma
Thyroid hormone resistance syndrome: occasional patients may have features of thyrotoxicosis
Chorionic gonadotropin-secreting tumorsᵃ
Gestational thyrotoxicosisᵃ
ᵃCirculating TSH levels are low in these forms of secondary hyperthyroidism. Abbreviation: TSH, thyroid-stimulating hormone.

1. 갑상샘 기능 항진증 (Hyperthyroidism)을 동반하는 경우 (RAIU 증가)
- Graves' disease (그레이브스병): 가장 흔함 (60-80%)
- Toxic multinodular goiter (중독성 다결절 매듭)
- Toxic adenoma (중독성 선종)
- TSH-secreting pituitary adenoma (매우 드묾)
- hCG-mediated (임신성, 융모상피암 등)
2. 갑상샘 기능 항진이 없는 경우 (RAIU 감소)
- Thyroiditis (갑상샘염): 저장된 호르몬의 누출 (Subacute, Silent, Postpartum)
- Exogenous hormone (외인성): Thyrotoxicosis factitia (약물 과다 복용)
- Ectopic thyroid: Struma ovarii (난소 갑상샘종)
- Drug-induced: Amiodarone (Type 2 effect)

[갑상샘 저하증 (Hypothyroidism)의 분류]

TABLE 395-1 Causes of Hypothyroidism
Primary
Autoimmune hypothyroidism: Hashimoto’s thyroiditis, atrophic thyroiditis
Iatrogenic: ¹³¹I treatment, subtotal or total thyroidectomy, external irradiation of neck for lymphoma or cancer
Drugs: iodine excess (including iodine-containing contrast media), amiodarone, lithium, antithyroid drugs, p-aminosalicylic acid, interferon α and other cytokines, aminoglutethimide, tyrosine kinase inhibitors (e.g., sunitinib), immune checkpoint inhibitors (e.g., ipilimumab, nivolumab, pembrolizumab)
Congenital hypothyroidism: absent or ectopic thyroid gland, dyshormonogenesis, TSH-R mutation
Iodine deficiency
Infiltrative disorders: amyloidosis, sarcoidosis, hemochromatosis, scleroderma, cystinosis, Riedel’s thyroiditis
Overexpression of type 3 deiodinase in infantile hemangioma and other tumors
Transient
Silent thyroiditis, including postpartum thyroiditis
Subacute thyroiditis
Withdrawal of supraphysiologic thyroxine treatment in individuals with an intact thyroid
After ¹³¹I treatment or subtotal thyroidectomy for Graves’ disease
Secondary
Hypopituitarism: tumors, pituitary surgery or irradiation, infiltrative disorders, Sheehan’s syndrome, trauma, genetic forms of combined pituitary hormone deficiencies
Isolated TSH deficiency or inactivity
Drugs: bexarotene, mitotane
Hypothalamic disease: tumors, trauma, infiltrative disorders, Prader-Willi syndrome

일차성 (Primary, TSH 상승)
- 자가면역성: Hashimoto's thyroiditis (하시모토 갑상샘염, 가장 흔함)
- 의인성 (Iatrogenic): 수술, 방사성 요오드 치료 후, 목 조사(Irradiation)
- 약물: Amiodarone, Lithium, Tyrosine kinase inhibitors, Immune checkpoint inhibitors
- 요오드 결핍 또는 과잉
- 선천성: Congenital hypothyroidism
이차성/중추성 (Central, TSH 정상/감소)
- 뇌하수체 종양, 쉬한 증후군 (Sheehan's syndrome), 외상
일시적 (Transient)
- Subacute thyroiditis, Silent thyroiditis, Postpartum thyroiditis의 회복기

[1] Harrison 22e, pg.3027, 3033

개요

갑상샘 생리학