임상갑상선학 (제4판) > Endocrinology

2001년에 임상갑상선학을 발간할 당시만 해도 제4판까지 발간하게 되리라고는 생각하지 못했다. 이제는 고인이 되신 은사 이문호 교수님과 고창순 교수님을 모시고 갑상선학을 공부하면서 환자 진료를 시작한지도 벌써 34년이 되었다. 그동안 갑상선학은 면역학, 분자생물학 등 기초 분야의 발전뿐만 아니라 핵의학적 검사법, 초음파를 비롯한 영상의학의 발전과 더불어 세포병리진단이 확립되면서 괄목할만한 발전을 이루었다. 특히 한국의 갑상선학은 상전벽해란 말이 어울리게 발전했다. 갑상선학을 전공하는 학자가 증가한 것은 물론이고 세계적 수준의 연구논문이 매년 수백 편씩 발표되는 등 질적으로도 일취월장하고 있다.
제3판을 발간한 2010년 이후 최근 3년 사이에 미국갑상선학회를 중심으로 각 지역의 학회들이 갑상선질환의 진단 및 치료 지침들을 발표하여 갑상선질환 환자 진료에 새로운 장이 열렸다. 특히 우리나라에서는 갑상선암의 발생률이 급증하면서 사회적 문제로 대두되었다. 최근 중앙암등록본부의 암발생률 통계에 의하면 갑상선암은 국내에서 발생하는 암 중 제일 흔한 암이 되었으며, 유두미소암이 전체 갑상선암의 절반 이상을 차지하면서 수술방법 및 수술 후 관리에 대해 논란이 되고 있어 이에 대한 정리가 필요해졌다. 또한 최근에 발표된 갑상선기능항진증, 갑상선기능저하증, 임신 중 갑상선질환의 관리에 대한 새로운 지침과 변화된 내용을 소개할 필요가 있어 제4판을 발간하기로 결정하였다. 제4판에서는 갑상선의 성장, 분화 및 세포자멸사와 갑상선 자가면역, 무증상 갑상선질환을 제외하였고, 대신 갑상선기능검사를 항목별로 나누고 갑상선암도 몇 개의 장으로 나누어 기술하였다.
저자가 갑상선학을 공부할 수 있도록 이끌어 주신 은사 고 이문호 선생님과 학문과 인생의 길잡이 역할을 해주신 은사 고 고창순 선생님의 은혜를 잊을 길이 없다. 지난 34년 동안 저자와 함께 연구실과 진료실에서 고락을 같이 했던 여러 선생님들께 감사를 드린다. 또한 항상 그늘에서 참고 지켜 봐 온 아내 손선영과 아이들 (아들, 딸, 며느리, 사위와 손자들)에게 감사한다. 이 책이 출판되도록 노력해 주신 고려의학 최병진 사장과 편집과 교정을 직접 맡아 수고해준 이창용 부장과 직원 여러분에게도 감사드린다.

목 차
제1장 갑상선 역사 ··· 1
제2장 갑상선 발생 및 구조
I. 갑상선 발생 ········································ 3
II. 갑상선 구조 ······································· 4
1. 육안소견 ································· 4
2. 혈관 · ···································· 5
3. 림프 · ···································· 5
4. 신경 · ···································· 5
5. 현미경적 구조 ····························· 6
III. 갑상선의 발생 이상 ···························· 7
IV. 갑상선 발생의 분자 기전 ····················· 7
1. 갑상선전사인자-1 ························· 8
2. 갑상선전사인자-2 ························· 9
3. Pax-8 ··································· 9
제3장 갑상선호르몬 합성 및 분비
I. 요오드대사 ······································· 11
1. 요오드공급, 흡수 및 배설 ·················· 11
2. 갑상선의 요오드섭취 및 운반 ··············· 12
II. 갑상선호르몬 합성 및 분비 ················· 18
1. 갑상선글로불린 ·························· 18
2. 갑상선과산화효소 ························· 21
3. 요오드의 산화 및 유기화 ··················· 21
4. 요오드티로신의 연결 ······················ 22
5. Tg의 분해 및 갑상선호르몬 방출 ············ 22
제4장 갑상선호르몬 운반, 세포섭취 및 대사
I. 갑상선호르몬 운반 ····························· 25
1. 갑상선호르몬결합단백의 물리화학적 성상 ···· 25
2. 갑상선호르몬결합단백의 선천적 이상 ········ 26
3. 갑상선호르몬결합단백에 영향 주는 후천적 인자 · 27
II. 갑상선호르몬의 세포섭취 ··················· 28
1. Organic anion transporting polypeptide ·· 28
2. Monocarboxylate transporter 8(MCT8) ·· 28
III. 갑상선호르몬 대사 ··························· 30
1. 갑상선호르몬 교체 및 역동 ················· 30
2. 갑상선호르몬 대사 ························ 31
3. 갑상선호르몬 대사의 생리학적 역할 ········· 36
4. 질환에서의 갑상선호르몬 대사 ·············· 37
제5장 갑상선호르몬의 작용
I. 갑상선호르몬수용체의 구조 ················· 43
1. DNA결합영역 ···························· 44
2. 리간드결합영역 ·························· 44
3. 겹첩영역 ································ 44
4. 아미노종단(A/B) 영역 ···················· 44
II. 갑상선호르몬수용체 동종형 ·············· 44
1. 베타 갑상선호르몬수용체 · ················· 45
2. 알파 갑상선호르몬수용체 · ················· 45
III. 갑상선호르몬수용체에 의한 전사 조절 · 46
1. 갑상선호르몬반응요소 ····················· 47
2. 갑상선호르몬수용체 보조억제물질 및 보조활성
물질 · ·································· 47
IV. 갑상선호르몬의 비유전체 작용 ··········· 52
V. 갑상선호르몬의 조직에 대한 효과 ········ 54
1. 골 · ····································· 54
2. 심장 · ··································· 55
3. 지방 · ··································· 56
4. 간 · ····································· 56
5. 뇌하수체 ································ 57
6. 뇌 · ····································· 57
7. 대사에 대한 영향 · ························ 58
임상갑상선학
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VI. 갑상선호르몬수용체의 유전자 돌연변이에
의한 표현형 ···································· 58
1. TRα knockout ·························· 58
2. TRβ knockout ·························· 60
3. TRα 및 TRβ knockout ··················· 60
제6장 갑상선기능의 조절
I. 갑상선자극호르몬 ······························ 65
1. TSH의 화학 및 생합성 ···················· 65
2. TSH의 작용기전 ·························· 67
II. TSH의 합성과 분비 조절 ···················· 67
1. 갑상선호르몬 ···························· 68
2. 갑상선자극호르몬분비호르몬 ··············· 68
3. 소마토스타틴의 역할 ······················ 70
4. 도파민 ·································· 70
5. 알파-아드레날린성 작용물질 ··············· 71
6. 세로토닌 및 다른 신경전달물질 ············· 71
7. 종양괴사인자와 시토카인 · ················· 72
8. 스테로이드호르몬 ························· 72
III. TSH 분비 양상의 변화 ······················ 72
1. TSH의 일중변동 ·························· 72
2. 온도, 나이 및 칼로리 제한의 영향 ··········· 72
3. 스트레스, 비갑상선질환 및 정신질환의 영향 ·· 73
4. 시상하부-뇌하수체 질환의 영향 ············ 74
IV. 갑상선기능의 자가조절 ····················· 75
제7장 갑상선기능에 미치는 환경인자 및 약제
의 영향
I. 외부 환경의 변화에 대한 갑상선의 반응 · 79
1. 온도 · ··································· 79
2. 고도 및 광선 ····························· 79
3. 영양상태 ································ 80
4. 무기물 ·································· 81
II. 물리적 및 정신적 스트레스에 대한 갑상선
반응 ··············································· 83
1. 수술 · ··································· 83
2. 급성 정신적 스트레스 ····················· 83
III. 약제 및 화학물 ································ 83
1. 갑상선종유발물질 ························· 83
2. 갑상선기능에 영향을 미치는 기타 약제 및 화학물
······································· 85
IV. 시토카인과 갑상선기능 ····················· 87
1. 요오드섭취에 대한 시토카인의 영향 ········· 87
2. 요오드유기화 및 갑상선글로불린합성에 대한
시토카인의 영향 ·························· 88
3. 갑상선호르몬분비에 대한 시토카인의 영향 ··· 88
4. 갑상선세포 성장에 미치는 시토카인의 영향 ··· 88
5. TSH 합성 및 분비에 미치는 시토카인의 영향 · 89
제8장 비갑상선질환증후군
I. 비갑상선질환에서 갑상선기능의 변화 ···· 91
1. 저T3 상태 ································ 91
2. 저T3-T4 상태 ····························· 92
3. 갑상선호르몬 역동의 변화 ················· 94
4. 비갑상선질환증후군에서 뇌하수체-갑상선 축의
변화 · ··································· 94
II. 비갑상선질환증후군에서 갑상선호르몬
변화의 기전 ····································· 96
1. 요오드티로닌 탈요오드효소 활성 억제 · ······ 96
2. 요오드티로닌의 세포막 통과 억제 ··········· 96
3. T4의 결합단백과의 결합 억제 ··············· 97
4. 시토카인의 억제 효과 ····················· 97
III. 특정 비갑상선질환에서의 갑상선기능 변화
···················································· 98
1. 간질환 ·································· 98
2. 신질환 ·································· 99
3. 정신질환 ································ 99
4. 후천성면역결핍증 ························· 99
IV. 비갑상선질환 환자에서 갑상선질환의 진단
···················································· 99
V. 예후 및 치료 ·································· 100
제9장 요오드와 갑상선질환
I. 역사 및 생태학 ································ 105
II. 흡수, 대사 ····································· 105
1. 요오드결핍에 대한 갑상선 적응 ············ 106
목차
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III. 요오드결핍질환 ································ 106
1. 풍토병갑상선종 ························· 107
2. 풍토병크레틴증 ························· 109
3. 진단 · ·································· 109
4. 치료 · ·································· 110
IV. 요오드-유발 갑상선질환 ················· 110
1. 요오드-유발 갑상선기능항진증 ············ 110
2. 요오드-유발 갑상선기능저하증 ············ 113
V. 아미오다론-유발 갑상선질환 ············ 115
1. 아미오다론의 약리 ······················· 115
2. 아미오다론이 갑상선에 미치는 영향 ········ 116
3. 아미오다론에 의한 갑상선기능장애 ········· 118
4. 아미오다론 치료 중인 환자의 추적 지침 ····· 124
제10장 갑상선호르몬, TSH, 갑상선글로불린 및
자가항체 측정
I. 갑상선호르몬 및 관련 물질의 측정 ······ 129
1. 갑상선호르몬의 측정 원리 및 방법 ········· 129
2. 혈청 총 T4 및 총 T3 측정 ·················· 130
3. 유리갑상선호르몬 측정 ··················· 133
4. 혈청 TSH 측정 ·························· 136
5. 갑상선 자가항체 측정 ···················· 139
6. 혈청 갑상선글로불린 측정 ················ 143
II. 갑상선기능검사의 임상응용 전략 ······· 146
1. 갑상선기능장애에 대한 스크리닝 ··········· 146
2. 갑상선기능의 감시 ······················· 148
3. 갑상선호르몬 측정 결과의 해석에서 유의할 사항
······································· 149
4. 갑상선호르몬측정 결과의 해석 및 임상응용 ·· 152
5. TRH 자극검사 ·························· 161
III. 갑상선기능의 대사, 생리 및 임상적 지표
·················································· 163
1. 기초대사율 ····························· 163
2. 아킬레스건반사 시간 ····················· 164
3. 혈청 콜레스테롤 ························· 164
4. 수축기시간간격 ························· 164
5. 근효소 ································· 164
6. 혈청 단백 및 효소 ························ 166
제11장 방사성요오드섭취율검사 및 스캔
I. 방사성요오드섭취율 및 관련 검사 ······· 171
1. 방사성요오드섭취율검사의 원리 및 목적 · ··· 171
2. 방사성요오드섭취율검사 방법 ············· 171
3. 방사성요오드섭취율검사의 판독 및 임상응용 · 171
4. 과염소산염방출시험 ······················ 173
5. T3 억제검사 ····························· 173
II. 갑상선스캔 ···································· 173
1. 핵종 · ·································· 173
2. 방법 · ·································· 174
3. 갑상선스캔의 적응증 ····················· 174
4. 갑상선질환의 갑상선스캔 소견 ············· 175
III. PET/CT 스캔 ································ 180
1. 갑상선암에서 FDG-PET 스캔의 적응증 ···· 181
2. FDG-PET 스캔에서 발견되는 갑상선 우연종의
진단적 의의 ····························· 181
3. FNA가 중간형이거나 반복적인 불충분한 검체로
나오는 결절에서 FDG-PET 스캔의 의의 ······ 181
4. 갑상선암에서 FDG-PET/CT 스캔의 의의 ·· 182
제12장 갑상선초음파 및 기타 비핵의학적 영상
검사
I. 갑상선초음파 ·································· 185
1. 방법 · ·································· 185
2. 판독 · ·································· 185
II. 전산화단층촬영 ······························ 195
1. 미만성 갑상선질환 ······················· 195
2. 다결절성 갑상선종 ······················· 195
3. 갑상선결절 ····························· 195
제13장 갑상선 세포병리
I. 미세침흡인세포검사의 적응증 ············ 197
1. 만져지는 갑상선결절의 FNA 적응증 ········ 198
2. 영상검사를 통해 발견된 갑상선결절의 FNA
적응증 ································· 198
3. 촉진 또는 초음파-유도 아래 시행하는 FNA
적응증 ································· 199
II. 방법 ············································· 199
1. 환자에 대한 설명 및 자세 · ················ 199
임상갑상선학
- viii -
2. 주사 바늘 선택과 흡인 방법 · ·············· 199
3. 도말, 고정 및 염색 ······················· 202
III. 세포검사의 판독 ···························· 203
1. 검체의 적절성 ··························· 203
2. FNA 판독에서 관찰할 기본 사항 ··········· 204
3. 갑상선 FNA의 진단 용어 및 분류 ·········· 204
4. 형태학적 진단기준 ······················· 206
IV. 미세침흡인세포검사의 정확도 ·········· 210
1. FNA 판독 성적 ·························· 210
제14장 갑상선질환의 임상진단 - 병력청취 및 신
체검진
I. 병력청취 ········································ 213
II. 갑상선 진찰 ··································· 215
1. 갑상선의 해부학적 위치 ·················· 215
2. 시진 · ·································· 215
3. 촉진 · ·································· 216
4. 청진 · ·································· 217
5. 위양성 및 위음성 갑상선종 ················ 217
제15장 갑상선기능항진증 - 그레이브스병
I. 정의 및 분류 ··································· 219
II. 그레이브스병 ································· 221
1. 원인 및 병인 ···························· 221
2. 빈도 및 유병률 · ························· 222
3. 임상소견 ······························· 223
4. 진단 · ·································· 247
5. 치료 · ·································· 256
III. 갑상선중독발증 ····························· 277
1. 병태생리 ······························· 277
2. 임상소견 ······························· 277
3. 진단 · ·································· 278
4. 치료 · ·································· 278
제16장 그레이브스 안병증, 갑상선피부병증 및
갑상선말단병증
I. 그레이브스 안병증 ··························· 285
1. 분류 · ·································· 285
2. 빈도 · ·································· 286
3. 소인 및 위험인자 · ······················· 288
4. 병리소견 및 병인 · ······················· 292
5. 임상소견 ······························· 297
6. 자연경과 및 이에 미치는 영향 ············· 301
7. 치료 · ·································· 304
8. 안병증 예방 ····························· 311
II. 그레이브스병의 피부병증 ················ 311
1. 임상상 ································· 312
2. 병리소견 ······························· 313
3. 병인 · ·································· 313
4. 치료 · ·································· 314
III. 갑상선말단병증 ····························· 315
1. 빈도 · ·································· 315
2. 임상상 ································· 315
3. 치료 및 경과 ···························· 317
제17장 다른 원인에 의한 갑상선중독증
I. 중독성 선종 및 중독성 다결절성 갑상선종
···················································· 323
1. 중독성 선종 ····························· 323
2. 중독성 다결절성 갑상선종 ················ 329
II. 가족성 및 선천성 비자가면역성
갑상선기능항진증 ··························· 330
III. TSH-분비뇌하수체종양 ················· 331
1. 빈도 및 분류 ···························· 331
2. 임상소견 ······························· 331
3. 검사소견 ······························· 332
4. 진단 및 감별진단 · ······················· 333
5. 치료 · ·································· 335
IV. 영양막종양 ··································· 336
1. 사람융모성성선자극호르몬과 갑상선자극 작용
·········································· 337
2. 임상상 ································· 337
3. 진단 · ·································· 337
4. 치료 · ·································· 338
목차
- ix -
제18장 갑상선기능저하증
I. 빈도 및 원인 ··································· 341
1. 정의 및 분류 ···························· 341
2. 역학 및 빈도 ···························· 342
3. 원인 · ·································· 344
II. 일차성 갑상선기능저하증의 임상소견 · 346
1. 얼굴, 피부 및 그 부속물 ·················· 346
2. 심맥관계 ······························· 348
3. 호흡기계 ······························· 352
4. 신장 및 전해질대사 ······················ 352
5. 위장관 및 간 ···························· 353
6. 혈액 · ·································· 354
7. 근육계 ································· 354
8. 신경정신계 ····························· 355
9. 내분비 ································· 356
10. 에너지 및 영양대사 ····················· 357
III. 진단 ············································ 358
1. 임상 진단 ······························· 358
2. 스크리닝 ······························· 359
3. 검사소견 ······························· 360
4. 진단적 접근 및 감별진단 ·················· 362
IV. 치료 ············································ 363
1. 갑상선호르몬 제제 ······················· 363
2. 흡수, 투여 시간 ························· 363
3. 치료용량, 경과 · ························· 364
4. 갑상선기능저하증 치료 중 나타나는 문제점 ·· 366
5. 무증상 갑상선기능저하증의 치료 ··········· 369
V. 점액부종 혼수 ································ 372
1. 임상소견 및 진단 · ······················· 372
2. 치료 · ·································· 373
VI. 중추성 갑상선기능저하증 ················ 373
1. 원인 · ·································· 373
2. 임상소견 ······························· 374
3. 진단 · ·································· 374
4. 치료 · ·································· 375
제19장 갑상선염
I. 급성 화농성 갑상선염 ······················· 379
1. 원인 및 병인 ···························· 379
2. 임상소견 및 진단 · ······················· 380
3. 치료 및 경과 ···························· 382
II. 아급성 갑상선염 ····························· 382
1. 빈도 · ·································· 382
2. 원인 · ·································· 382
3. 병리 및 병인 ···························· 382
4. 임상소견 ······························· 383
5. 검사소견 ······························· 385
6. 진단 및 감별진단 · ······················· 386
7. 치료 및 경과 ···························· 386
III. 무통성 갑상선염 ···························· 387
1. 빈도 · ·································· 387
2. 원인 · ·································· 387
3. 병리 · ·································· 388
4. 임상소견 ······························· 388
5. 검사소견 ······························· 388
6. 진단 및 치료 ···························· 389
IV. 만성 림프구성 갑상선염 ·················· 391
1. 빈도 · ·································· 391
2. 병리 및 발병기전 · ······················· 391
3. 임상소견 ······························· 393
4. 검사소견 ······························· 395
5. 하시모토 갑상선염의 임상 변형 ············ 395
6. 진단 및 치료 ···························· 397
7. 경과 · ·································· 397
V. 약제-유발 갑상선염 ························ 398
1. 아미오다론-유발 갑상선염 ················ 398
2. 리치움 ································· 399
3. Interferon α 및 IL-2 ···················· 399
VI. 리델 갑상선염 ······························· 399
제20장 비중독성 미만성 및 결절성 갑상선종
I. 정의 ·············································· 403
II. 원인 ············································· 403
III. 병리 및 병인 ································· 404
1. 병리 · ·································· 404
2. 병인 · ·································· 404
IV. 임상소견 ······································ 406
1. 빈도 · ·································· 406
2. 임상상 ································· 406
V. 진단 ············································· 407
임상갑상선학
- x -
VI. 치료 ············································ 408
1. 수술 · ·································· 408
2. 방사성요오드 ··························· 408
3. T4 억제요법 ····························· 409
4. 치료법 선택 ····························· 409
VII. 경과 및 예후 ································ 410
VIII. 흉골하갑상선종 ··························· 410
1. 원인 · ·································· 410
2. 빈도 · ·································· 410
3. 분류 · ·································· 411
4. 임상소견 ······························· 411
5. 진단 및 치료 ···························· 411
제21장 갑상선결절
I. 정의, 빈도 ······································ 415
1. 정의 · ·································· 415
2. 빈도 · ·································· 415
II. 병리학적 분류 및 병인 ····················· 416
1. 갑상선결절의 조직학적 분류 ·············· 416
2. 병리학적 감별진단 ······················· 419
III. 자연경과 ······································ 420
IV. 임상소견과 진단 ···························· 421
1. 병력 · ·································· 421
2. 증상 및 징후 ···························· 421
3. 악성결절과 양성결절의 감별 ·············· 422
4. 검사소견 ······························· 423
5. 진단적 접근과 치료법 선택 ················ 436
V. FNA 결과에 따른 갑상선결절의 치료 및
관리 ············································· 439
1. 비진단적 FNA 결과 ······················ 439
2. 양성결절 ······························· 439
3. 의미 불확정 비정형성/의미 불확정 여포성 병변
FNA 결과 ····························· 441
4. 여포성 종양/허들세포 종양 ··············· 441
5. 악성 의심 FNA ·························· 442
6. 악성결절 ······························· 442
VI. 특별한 조건의 갑상선결절 관리 ········ 442
1. 낭성결절의 치료 및 관리 ·················· 442
2. 비중독성 다결절성 갑상선종의 치료 및 관리 · 444
3. 자율기능성 갑상선결절 ··················· 445
4. 임신 중 갑상선결절의 치료 및 관리 ········· 445
제22장 갑상선암-역학, 병인
I. 갑상선암의 역학 ······························ 451
1. 빈도 · ·································· 451
2. 위험인자 및 유발인자 ···················· 456
II. 갑상선암의 분자 병인론 ··················· 462
1. 갑상선 여포세포 증식의 조절 ·············· 462
2. 갑상선종양에서 나타나는 분자 수준의 이상 ·· 462
3. 갑상선종양 발생의 단계적 기전 ············ 475
제23장 갑상선 분화암
I. 임상소견 및 감별진단 ······················· 483
1. 병력 · ·································· 483
2. 이학적소견 ····························· 483
3. 원격전이의 임상소견 ····················· 484
4. 진단 · ·································· 484
II. 예후 및 병기분류 ···························· 484
1. 사망률 ································· 484
2. 예후 · ·································· 485
3. 병기분류 ······························· 498
III. 일차치료 ······································ 503
1. 수술 · ·································· 503
2. 방사성요오드치료 ························ 511
3. TSH 억제요법 ·························· 520
4. 외부방사선조사 또는 화학요법 ············· 523
IV. 일차치료 후 장기 추적관리 ·············· 523
1. 장기 추적의 목표 및 의의 · ················ 523
2. 장기 추적에서 재발 위험에 따른 환자 분류 ·· 524
3. 장기 추적관찰에서 사용하는 진단방법 · ····· 524
4. 일차치료가 완료된 저위험군 환자의 경과관찰 · 530
5. 131I 전신스캔이 음성이며 혈청 Tg는 증가한
경우의 경과관찰 ························· 531
6. Tg 항체가 양성인 경우의 경과관찰 ········· 533
7. 갑상선 잔여조직이 남아 있는 경우의 경과관찰 · 535
8. 일차치료 후 위험 층화와 장기 추적관리 ····· 535
V. 재발, 전이병소 및 131I 불응성 분화암에
대한 치료 ······································ 536
1. 국소전이 환자의 치료 ···················· 537
목차
- xi -
2. 호흡소화관 침입 환자의 수술요법 ·········· 537
3. 폐전이의 치료 ··························· 538
4. 골전이의 치료 ··························· 538
5. 뇌전이의 치료 ··························· 539
6. 외부방사선조사 ························· 540
7. 항암약물치료 ··························· 540
8. 진행성 갑상선 분화암의 새로운 분자표적치료법
······································ 540
VI. 방사선요오드치료 부작용에 대한 대책 · 545
제24장 갑상선 수질암 및 제2형 다발성내분비
선종
I. 분류 및 역학 ··································· 555
II. 병리 및 분자 종양발생기전 ··············· 556
1. 병리 · ·································· 556
2. C-세포 증식 ···························· 557
3. C 세포 분비물 ··························· 557
4. 분자 종양발생기전 ······················· 558
III. 임상소견 ······································ 562
1. 산발형 갑상선 수질암 ···················· 562
2. MEN 2A ······························· 563
3. MEN 2B ······························· 564
4. 가족성 갑상선 수질암 ···················· 564
IV. 진단 ············································ 564
1. 임상적으로 명백한 갑상선 수질암 ·········· 564
2. MEN 2 증후군의 스크리닝 ··············· 565
V. 치료, 경과관찰 및 예후 ···················· 567
1. 수술 전 검사 ···························· 567
2. 수술 · ·································· 567
3. 수술 후 경과 관찰 ························ 568
4. 장기간 추적 및 처치 ······················ 571
5. 예후 · ·································· 571
VI. 가족형 수질암 환자 가족에서
예방갑상선절제술 ·························· 571
VII. 갑상선 수질암의 분자표적치료 ········ 573
제25장 역형성 갑상선암 및 기타 암
I. 역형성 갑상선암 ······························ 577
1. 빈도 및 역학 ···························· 577
2. 원인 · ·································· 578
3. 병리 · ·································· 580
4. 임상소견 ······························· 582
5. 병기분류, 사망률 및 예후 ················· 582
6. 치료 · ·································· 584
II. 갑상선 림프종 ································ 588
1. 빈도 · ·································· 588
2. 원인: 하시모토 갑상선염과의 관계 ········· 589
3. 병리 · ·································· 589
4. 임상소견 ······························· 589
5. 진단 및 병기분류 · ······················· 591
6. 예후 · ·································· 591
7. 치료 · ·································· 592
제26장 임신과 갑상선
I. 모체 갑상선기능 ······························ 595
1. 정상 임신에서의 갑상선기능 조절 ·········· 595
2. 임신 중 갑상선호르몬 농도의 변화 ········· 597
3. 임신 중의 갑상선종 ······················ 599
II. 태아 갑상선기능 ····························· 600
1. 개체발생 ······························· 600
2. 임신 중 태아 갑상선호르몬 변화 ··········· 600
3. 양수의 갑상선호르몬 ····················· 601
4. 모체-태반-태아의 상호작용 ··············· 601
5. 출생 후 갑상선기능 변화 ·················· 602
III. 임신 중 및 출산 후의 갑상선기능항진증
·················································· 602
1. 임신 중 모체 갑상선기능항진증 ············ 602
2. 태아 및 신생아 갑상선기능항진증 ·········· 610
3. 임신입덧 및 임신일과성갑상선기능항진증 ··· 612
4. 산후갑상선중독증 ························ 613
IV. 임신 중의 갑상선기능저하증 ············ 613
1. 모체 갑상선기능저하증 ··················· 613
2. 태아 및 신생아 갑상선기능저하증 ·········· 621
V. 임신 중의 갑상선결절 및 암 ·············· 622
1. 갑상선결절의 빈도, 병리 및 성장 ··········· 622
2. 임신 중 갑상선결절에 대한 접근 ··········· 623
임상갑상선학
- xii -
3. 새로 진단한 갑상선암의 수술 적응증 ······· 624
4. 과거에 갑상선암으로 진단된 환자의 관리 ··· 624
VI. 임신과 자가면역성 갑상선질환 ········· 625
1. 임신 중 면역현상의 변화 ·················· 625
2. 출산 후 면역 변화 ························ 627
3. 임신과 자가면역성 갑상선질환 ············· 628
VII. 임신과 요오드섭취 ························ 629
VIII. 산후 갑상선염 ····························· 630
1. 유병률 ································· 630
2. 원인 및 위험인자 · ······················· 630
3. 임상소견 및 경과 · ······················· 635
4. 진단 · ·································· 636
5. 추적 관찰 및 예후 ························ 637
6. 치료 · ·································· 637
7. 스크리닝, 예방 · ························· 638
IX. 임신 중 갑상선기능장애에 대한 스크리닝
·················································· 639
제27장 노인에서의 갑상선질환
I. 연령 증가에 따른 갑상선의 형태적 변화 · 645
II. 노인에서의 갑상선생리 ···················· 645
1. 갑상선호르몬의 합성, 분비 및 대사 ········· 645
2. 시상하부-뇌하수체-갑상선 축 ············· 646
III. 노인에서의 갑상선질환 ··················· 647
1. 갑상선기능저하증 ························ 647
2. 갑상선기능항진증 ························ 649
3. 갑상선 결절 및 암 ························ 651
제28장 갑상선호르몬내성증후군
I. 갑상선호르몬수용체 결손에 의한
갑성선호르몬내성증후군 ··················· 656
1. 베타 갑상선호르몬수용체 유전자 돌연변이 ·· 656
2. 알파 갑상선호르몬수용체 유전자 돌연변이 ·· 662
II. 갑상선호르몬운반 결손 ···················· 663
1. 임상소견 ······························· 663
2. 검사소견 및 진단 · ······················· 663
3. 발병기전 ······························· 663
4. 치료 · ·································· 663
III. 갑상선호르몬대사 결손 ··················· 664
1. 세포내 갑상선호르몬대사 · ················ 664
2. 임상소견 ······························· 664
3. 검사소견 및 감별진단 ···················· 664
4. 치료 · ·································· 664
제29장 선천성 갑상선질환
I. 선천성 갑상선기능저하증 ·················· 667
1. 원인별 분류 및 빈도 ······················ 667
2. 임상소견 ······························· 668
3. 진단 · ·································· 668
4. 치료 · ·································· 669
II. 갑상선발생의 유전적 결손 ················ 669
1. TITF1 결손 ····························· 670
2. FOXE1 결손 ···························· 670
3. PAX8 돌연변이 ························· 671
III. 갑상선호르몬합성의 유전적 결손 ······ 671
1. 시상하부-뇌하수체 결손 ·················· 671
2. 갑상선 여포세포 수준에서 호르몬합성장애 ·· 673
3. 갑상선호르몬결합단백 이상 · ·············· 677
IV. 갑상선발생 이상 ···························· 677
1. 갑상설관낭 ····························· 677
2. 이소갑상선 ····························· 677
3. 갑상선 편측무발생 ······················· 678
찾아보기 ··········································· 683
INDEX ·············································· 691