异基因造血干细胞移植术后并发甲状腺功能亢进的临床分析

Hyperthyroidism after Allogeneic Hematopoietic Stem Cell Transplantation

目的:探讨异基因造血干细胞移植术后并发甲状腺功能亢进的临床特点、发病机制、治疗及预后情况。方法:回顾性分析中国人民解放军空军特色医学中心7例异基因造血干细胞移植术后并发甲状腺功能亢进患者的临床资料。结果:7例患者中,男5例,女2例,中位年龄为25(7-32)岁,儿童1例,其余6例为成人,急性白血病3例,慢性粒细胞白血病1例,骨髓增生异常综合征1例,重型再生障碍性贫血2例。6例患者接受单倍体相合造血干细胞移植,1例接受无关供者全相合造血干细胞移植。所有患者均未应用含全身照射(TBI)的预处理方案,发生甲状腺功能亢进中位时间为20(9-25)个月。2例患者在诊断甲亢时合并慢性移植物抗宿主病,经激素及抗排异治疗后,甲亢得到控制,但其中1例在3个月后出现甲状腺功能减退症状,需要长期口服左甲状腺素维持。1例应用131I治疗后出现甲状腺功能减退症状,其余4例患者均应用甲巯咪唑治疗,3例甲状腺功能正常,1例在口服甲巯咪唑后1年出现甲状腺功能减退症状,口服左甲状腺素片维持治疗。结论:异基因造血干细胞移植术后甲状腺功能亢进是少见并发症,但严重影响患者生活质量,移植后长期存活患者需定期监测甲状腺功能,治疗上需根据引起甲状腺功能亢进的原因进行。

Objective:To investigate the clinical characteristics,etiology,therapy and outcome of hyperthyroidism after allogeneic hematopoietic stem cell transplantation(HSCT).Methods:The clinical data of 7 patients who experienced hyperthyroidism were retrospectively analyzed in our hospital.Results:These 7 patients(5 males,2 females)suffered hyperthyroidism after HSCT.All patients did not apply the pretreatment regimen containing total body irradiation(TBI).The median age was 25 years old,only one child.Six patients underwent haploidentical HSCT except one patient after unrelated HSCT.The median time of hyperthyroidism occurrence was 20 months.Two patients experienced chronic graft versus host disease(GVHD)when hyperthyroidism occurred and were treated successfully with glucocorticoid,however one patient suffered hypothyroidism 3 months later and needed long-term oral levothyroxine maintenance.One patient developed hypothyroidism post treatment of 131I.The other four patients were treated with methimazole and all of them showed normal thyroid function except one patient suffered from hypothyroidism 1 year later and needed long-term oral levothyroxine maintenance.Conclusion:Hyperthyroidism is a rare complication after HSCT but may affect healthy and lead to lower quality of life.Routine thyroid function monitoring should be recommended after HSCT.Treatment of hyperthyroidism should be given according to the pathogeny.