Cranial irradiation and central hypothyroidism
Cranial irradiation and central hypothyroidism
复制标题
颅脑照射与中枢性甲状腺功能减退症
DOI：
10.1016/s1043-2760(00)00359-3
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发表时间：
2001
影响因子：
10.9
通讯作者：
S. Rose
中科院分区：
文献类型：
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作者：
S. Rose
颅脑照射可引起促甲状腺激素（TSH）释放激素（TRH）分泌异常。TRH缺乏会导致TSH α和β亚基糖基化异常，以及TSH分泌的正常昼夜模式丧失（下午低，晚上激增，晚上高）。这种破坏导致混合性甲状腺功能减退症（TSH升高伴分泌动力学异常）或中枢性甲状腺功能减退症（分泌动力学异常，但TSH未升高）。虽然原发性甲状腺功能减退症在一般人群和癌症幸存者中更常见，但在颅照射后的十年内，中枢性和混合性甲状腺功能减退症的累积发病率很高。监测游离甲状腺素（FT4）的下降和血清TSH的升高，并使用TSH峰和TRH试验早期识别，具有临床价值。早期甲状腺激素替代治疗使血清FT4达到正常范围的上半部分对于维持癌症幸存者的最佳健康和生长至关重要。
Cranial irradiation causes thyrotropin (TSH)-releasing hormone (TRH) secretory abnormalities. TRH deficiency leads to abnormal glycosylation of TSH α and β subunits and loss of the normal circadian pattern of TSH secretion (low in the afternoon, a surge in the evening, higher at night). This disruption results in either mixed hypothyroidism (raised TSH with abnormal secretory kinetics) or central hypothyroidism (abnormal secretory kinetics without raised TSH). Although primary hypothyroidism is more common in the general population and cancer survivors, the cumulative incidence of central and mixed hypothyroidism is high during the ten years after cranial irradiation. Monitoring for decline in free thyroxine (FT4) and rise in serum TSH, and early recognition using TSH surge and TRH tests, are clinically valuable. Early thyroid hormone replacement therapy to achieve serum FT4in the upper half of the normal range is crucial for maintaining optimal health and growth in cancer survivors.