Borgström B, Bolme P
Department of Pediatrics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Bone Marrow Transplant. 1994 Jan;13(1):59-64.
Thyroid function was investigated in 35 children after allogeneic BMT. The study was longitudinal and all patients were followed for at least 5 years. Once a year TSH, T4, T3 and the TRH test were performed. Patients with severe aplastic anemia (n = 6) were transplanted without total body irradiation (TBI) and they had no detectable alterations in thyroid function. Patients with leukemia (n = 27) were conditioned with 10 Gy TBI in one fraction. The accumulated frequencies of thyroid dysfunction were 3 of 27 (11%) with high TSH and low T3 or T4 levels, and 10 of 27 (37%) with high basal TSH and normal T3 and T4 levels. An additional 11 of 27 (41%) had an exaggerated TSH response in the TRH test and normal basal TSH and T3/T4 levels. Only 3 of 27 (11%) continued to have normal values. Treatment with levo-thyroxine (L-T4) was given to the patients with a high basal TSH level. As 24 of 27 (89%) children had signs of disturbance in the thyroid axis, prophylactic L-T4 treatment for a few years after BMT with TBI may be of value. The main cause of a change in thyroid function after BMT seems to be conditioning with TBI.
对35名接受异基因骨髓移植（BMT）后的儿童进行了甲状腺功能研究。该研究为纵向研究，所有患者均随访至少5年。每年进行一次促甲状腺激素（TSH）、甲状腺素（T4）、三碘甲状腺原氨酸（T3）检测及促甲状腺激素释放激素（TRH）试验。6名重型再生障碍性贫血患者未接受全身照射（TBI）进行移植，其甲状腺功能未发现明显改变。27名白血病患者接受单次10 Gy的TBI预处理。甲状腺功能障碍的累积发生率为：27例中有3例（11%）TSH升高且T3或T4水平降低，27例中有10例（37%）基础TSH升高但T3和T4水平正常。另外27例中有11例（41%）在TRH试验中TSH反应过度，基础TSH及T3/T4水平正常。27例中只有3例（11%）甲状腺功能持续正常。对基础TSH水平高的患者给予左甲状腺素（L-T4）治疗。由于27例儿童中有24例（89%）存在甲状腺轴功能紊乱迹象，因此对接受TBI的BMT患者在术后几年进行预防性L-T4治疗可能有价值。BMT后甲状腺功能改变的主要原因似乎是TBI预处理。
