THYROID-FUNCTION AFTER TREATMENT OF BRAIN-TUMORS IN CHILDREN
THYROID-FUNCTION AFTER TREATMENT OF BRAIN-TUMORS IN CHILDREN
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DOI：
10.1016/s0022-3476(05)80288-4
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发表时间：
1991-11-01
影响因子：
5.1
通讯作者：
GATTAMANENI, HR
中科院分区：
文献类型：
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作者：
OGILVYSTUART, AL;SHALET, SM;GATTAMANENI, HR
在134名接受脑肿瘤治疗的儿童中，不涉及下丘脑-垂体轴，甲状腺功能在颅脑或颅脊髓照射治疗后长达24年。此外，78名儿童接受了长达2年的细胞毒性化疗。85例接受颅脊髓照射的儿童中，30例（35%）有甲状腺功能异常，49例接受颅脊髓照射的儿童中有10例（20%）有甲状腺功能异常。弗兰克甲状腺功能减退3例，甲状腺毒症1例。36名儿童在甲状腺素水平正常的情况下促甲状腺激素水平升高；其中16名患者的促甲状腺激素水平随后恢复正常。在1960年至1970年间接受治疗的28名儿童被排除在分析之外。34例接受颅脑照射的儿童中，5例有甲状腺功能障碍，72例接受颅脑照射的儿童中有24例有甲状腺功能障碍（p = 0.013）。35名未接受化疗的儿童中有4名存在甲状腺功能障碍，71名接受化疗的儿童中有25名存在甲状腺功能障碍（p = 0.014）。直接照射加化疗比单独照射损伤更大。这些数据证实，当甲状腺被纳入辐射领域时，甲状腺功能障碍的发生率很高。然而，在很大比例，甲状腺异常是轻微的，并随着时间的推移恢复正常；终身甲状腺素替代治疗可能是不必要的。
In 134 children who had been treated for a brain tumor not involving the hypothalamic-pituitary axis, thyroid function was assessed up to 24 years after treatment with cranial or craniospinal irradiation. In addition, 78 children received up to 2 years of cytotoxic chemotherapy. Of 85 children who received craniospinal irradiation, 30 (35%) had abnormalities of thyroid function, and 10 (20%) of 49 who received cranial irradiation had such abnormalities. Frank hypothyroidism developed in three children and thyrotoxicosis in one. Thirty-six children had an elevated thyroid-stimulating hormone level in the presence of a normal thyroxine level; in 16 of them the thyroid-stimulating hormone level subsequently returned to normal. Twenty-eight children who were treated between 1960 and 1970 were excluded from the analysis. Of 34 children who received cranial irradiation, five had thyroid dysfunction and 24 of 72 who received craniospinal irradiation had such dysfunction (p = 0.013). Thyroid dysfunction was present in 4 of 35 children who received no chemotherapy and in 25 of 71 who received chemotherapy (p = 0.014). Direct irradiation plus chemotherapy was more damaging than irradiation alone. These data confirm the high incidence of thyroid dysfunction when the thyroid gland is included in the radiation field. However, in a high proportion, the thyroid abnormalities are minor and revert to normal with time; life-long replacement therapy with thyroxine may be unnecessary.