Thyroid toxicity of treatment for Hodgkin's disease
Thyroid toxicity of treatment for Hodgkin's disease
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DOI：
10.1007/s002770050565
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发表时间：
2000-03-01
影响因子：
3.5
通讯作者：
Bokemeyer, C
中科院分区：
文献类型：
--
作者：
Bethge, W;Guggenberger, D;Bokemeyer, C
甲状腺疾病，特别是甲状腺功能减退症，是霍奇金病治疗中较常见的晚期内分泌后遗症之一。我们分析了177例患者的甲状腺功能（92名男性和85名女性），在1970年至1995年期间接受过霍奇金病治疗;他们的平均年龄是38岁（范围18-74），治疗后中位时间为6年单纯化疗（COPP/ABVD）35例（20%），单纯放疗（RTX）44例（25%）。98例（55%）根据德国霍奇金病研究组的方案接受综合治疗。所有患者至少1年内无疾病证据。在1994年至1997年期间，通过临床检查、甲状腺功能检查和超声成像（如有指征）对他们的甲状腺疾病进行评估。总体而言，发现48例患者（27%）患有亚临床（36例患者，20%）或明显（12例患者，7%）甲状腺功能减退症。单纯化疗组无一例发生甲状腺功能减退。而单纯放疗组44例中有15例（34%），联合放疗组98例中有33例（34%）。所有甲状腺功能减退症患者均接受了某种形式的膈上放射治疗，只有1例患者接受了膈下放射治疗，但为了分期，在此之前进行了半甲状腺切除术。经过平均6年的随访，27%的霍奇金病患者接受单独放疗或放疗和化疗联合治疗后出现甲状腺功能减退症。膈上放射，而不是单独使用化疗，与甲状腺功能减退症的风险增加有关。治疗后评估甲状腺功能很重要，应开始适当的替代药物治疗。
Thyroid disease, especially hypothyroidism, is one of the more frequently encountered late endocrine sequelae of treatment for Hodgkin's disease. We analyzed the thyroid function of 177 patients (92 male and 85 female) who had been treated for Hodgkin's disease between 1970 and 1995; their median age was 38 years (range 18-74) and their median time after therapy was 6 years (range 1-20), Thirty-five (20%) patients were treated with chemotherapy alone (mainly COPP/ABVD), 44 (25%) with radiotherapy (RTX) alone. and 98 (55%) received combined modality treatment according to the protocols of the German Hodgkin's Disease Study Group. All patients had been without evidence of disease for at least 1 year. They were evaluated between 1994 and 1997 for thyroid disease by clinical examination, thyroid function tests, and ultrasound imaging if indicated. Overall, 48 patients (27%) were found to have subclinical (36 patients, 20%) or overt (12 patients, 7%) hypothyroidism. No patient in the group treated with chemotherapy alone developed hypothyroidism. in contrast to 15 of 44 (34%) patients treated with radiotherapy alone and 33 of 98 (34%) patients treated with the combined modality approach who did. All patients with hypothyroidism had received some form of supradiaphragmatic radiation except one patient who underwent infradiaphragmatic RTX but with preceding hemithyroidectomy for staging purposes. After an average follow-up of 6 years, 27% of patients treated fur Hodgkin's disease with either radiotherapy alone or a combination of radiotherapy and chemotherapy developed hypothyroidism. Supradiaphragmatic radiation, but not the use of chemotherapy alone, is associated with an increased risk for hypothyroidism. Evaluation of thyroid function after therapy is important, and appropriate substitution medication should be initiated.