Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Short-term follow up of thyroid function after pediatric hematopoietic stem cell transplantation

소아 조혈모세포이식 후 단기간 갑상선 기능의 변화

  • Lee, Seon-Ju (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae-Wook (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dae-Hyoung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Young-Joo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Park, Young-Shil (Department of Pediatrics, College of Medicine, Kyung Hee University) ;
  • Hwang, Hui Sung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sun Young (Department of Pediatircs, College of Medicine, Chungnam National University) ;
  • Park, Ji Kyoung (Department of Pediatrics, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Jang, Pil-Sang (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jung, Min-Ho (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Chung, Nak-Gyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Dae-Chul (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Cho, Bin (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hack-Ki (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Byung-Churl (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 이선주 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이재욱 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이대형 (가톨릭대학교 의과대학 소아과학교실) ;
  • 권영주 (가톨릭대학교 의과대학 소아과학교실) ;
  • 박영실 (경희대학교 의과대학 소아과학교실) ;
  • 황희승 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김선영 (충남대학교 의과대학 소아과학교실) ;
  • 박지경 (인제대학교 의과대학 부산백병원 소아과) ;
  • 장필상 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정민호 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정낙균 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정대철 (가톨릭대학교 의과대학 소아과학교실) ;
  • 조빈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김학기 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이병철 (가톨릭대학교 의과대학 소아과학교실)
  • Received : 2006.08.10
  • Accepted : 2006.09.13
  • Published : 2006.11.15
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Abstract

Purpose : In this study, we analyzed the short term changes of thyroid function, incidence and risk factors of thyroid dysfunction soon after allogeneic hematopoietic stem cell transplantation (HSCT) in children. Methods : We enrolled 80 pediatric patients following allogeneic HSCT, at the Catholic HSCT center between January, 2004 and February, 2006. Serum TSH (thyroid stimulating hormone), total serum thyroxine and total serum triiodothyronine levels were systematically measured in 80 patients before the HSCT, and at 1 month, 6 months and 12 months after HSCT. Results : Thyroid function statistically decreased at 1 month after HSCT(P<0.001). Thyroid dysfunction at 1 month was observed in 43 (54 percent) of 80 patients, 31 (39 percent) of whom presented with euthyroid sick syndrome (ETS). Thyroid dysfunction was normalized within 1 year after HSCT. In univariate analysis, malignant disease and the presence of acute graft-versus-host disease (grade ${\geq}II$) were risk factors for ETS (P=0.04, 0.01 respectively). In multivariate analysis, we could not detect an independent risk factor for ETS (P=0.19, 0.06 respectively). Conclusion : The present study suggests that the incidence of thyroid dysfunction is high after allogeneic HSCT. Therefore, regular monitoring of thyroid hormone levels after HSCT is required.

목 적 : 본 연구는 소아 동종 조혈모세포이식 후에 갑상선 기능의 단기간 변화와 갑상선기능이상의 빈도와 위험인자를 분석하고자 하였다. 방 법 : 2004년 1월부터 2006년 2월까지 가톨릭대학교 성모병원 소아과, 조혈모세포이식센터에서 동종 조혈모세포이식을 시행한 80명의 환자를 대상으로 연구를 하였다. 조혈모세포이식 전과 이식 후 1개월, 6개월, 12개월에 환자들의 혈청에서 TSH, T4, T3를 측정하였다. 결 과 : 조혈모세포이식을 하고 1개월 후의 갑상선 기능은 통계적으로 유의한 감소를 보이고 있었다(P<0.001). 1개월 후 갑상선 기능이상의 빈도는 80명중 43명(54%)에서 보였으며 이들 중 31명(39%)은 ETS를 보이고 있었다. 이식 후 일년 이내 갑상선 기능은 대부분 정상으로 회복되었다. 단변량 분석에 의하면 악성 질환인 경우(P=0.04)와 2도 이상의 급성 이식편대 숙주병(P=0.01)이 ETS의 위험인자였으나(P=0.04), 다변량 분석에 의하면 ETS 발생에 독립적인 위험인자는 찾을 수 없었다(P=0.19, 0.06). 결 론 : 조혈모세포이식 후 갑상선 기능이상은 초기에 높은 빈도로 발생함을 알 수 있었다. 따라서 이식 후에는 갑상선 기능의 지속적인 추적검사가 필요하다.

Keywords

References

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