Abstract：
OBJECTIVE: To evaluate the prevalence of thyroid dysfunction and its association with possible contributing factors related to diagnosis and treatment in children who received hematopoietic stem cell transplantation (HSCT) in the only national transplant unit in Greece.
METHODS: This is an observational, retrospective, single center cohort study that included 194 patients (58.6% boys) who survived for at least 1 year following allogeneic HSCT. Conditioning regimens depended upon diagnosis and protocols active at the time of transplantation. Some patients received irradiation, either central nervous system prophylaxis (n = 20), or total body irradiation (TBI) (n = 8). Thyroid gland evaluation included thyroid-stimulating hormone, free thyroxine, thyroid autoantibodies, and sonogram. Univariate and multivariate logistic models were used to examine the association of the above-mentioned factors with hypothyroidism.
RESULTS: The mean age at diagnosis and at bone marrow transplant (BMT) in years was 7.51 ± 0.46 and 7.58 ± 0.36, respectively. The median follow-up time was 4.83 years. Hypothyroidism was detected in 33 cases (17.7%), four of those patients having received TBI. Factors contributing to hypothyroidism as per the multivariate analysis were male sex, [OR: 3.005, 95% CI (1.145-7.890)], irradiation, [OR: 2.876, 95% CI (1.120-7.386)], and years after HSCT [OR: 1.148, 95% CI (1.042-1.266)], while malignancy was identified only in the univariate analysis. The multivariate model presents a good class separation capacity [AUC = 72%, 95% CI (61.4%-82.4%)], Two patients had papillary thyroid cancer, both among children who had received TBI.
CONCLUSIONS: These data highlight the fact that male sex and radiotherapy are two independent factors that lead to increased risk for hypothyroidism. Furthermore, the prevalence of hypothyroidism increases with time post HSCT.
METHODS: This is an observational, retrospective, single center cohort study that included 194 patients (58.6% boys) who survived for at least 1 year following allogeneic HSCT. Conditioning regimens depended upon diagnosis and protocols active at the time of transplantation. Some patients received irradiation, either central nervous system prophylaxis (n = 20), or total body irradiation (TBI) (n = 8). Thyroid gland evaluation included thyroid-stimulating hormone, free thyroxine, thyroid autoantibodies, and sonogram. Univariate and multivariate logistic models were used to examine the association of the above-mentioned factors with hypothyroidism.
RESULTS: The mean age at diagnosis and at bone marrow transplant (BMT) in years was 7.51 ± 0.46 and 7.58 ± 0.36, respectively. The median follow-up time was 4.83 years. Hypothyroidism was detected in 33 cases (17.7%), four of those patients having received TBI. Factors contributing to hypothyroidism as per the multivariate analysis were male sex, [OR: 3.005, 95% CI (1.145-7.890)], irradiation, [OR: 2.876, 95% CI (1.120-7.386)], and years after HSCT [OR: 1.148, 95% CI (1.042-1.266)], while malignancy was identified only in the univariate analysis. The multivariate model presents a good class separation capacity [AUC = 72%, 95% CI (61.4%-82.4%)], Two patients had papillary thyroid cancer, both among children who had received TBI.
CONCLUSIONS: These data highlight the fact that male sex and radiotherapy are two independent factors that lead to increased risk for hypothyroidism. Furthermore, the prevalence of hypothyroidism increases with time post HSCT.
摘要：
目的：评估在希腊唯一的国家移植单位接受造血干细胞移植（HSCT）的儿童中，甲状腺功能障碍的患病率及其与诊断和治疗相关的可能因素的关系。
方法：这是一个观察性的，回顾性,单中心队列研究,纳入194例(58.6%为男孩)在同种异体HSCT后存活至少1年的患者。调节方案取决于移植时的诊断和活性方案。一些患者接受了照射，无论是中枢神经系统预防（n=20），或全身照射(TBI)(n=8)。甲状腺评估包括促甲状腺激素，游离甲状腺素,甲状腺自身抗体，还有超声波图.使用单变量和多变量逻辑模型来检查上述因素与甲状腺功能减退症的关联。
结果：诊断和骨髓移植（BMT）的平均年龄分别为7.51±0.46和7.58±0.36。中位随访时间为4.83年。甲状腺功能减退33例(17.7%),其中四名患者接受了TBI。根据多变量分析，导致甲状腺功能减退的因素是男性，[OR：3.005，95%CI（1.145-7.890）]，辐照，[OR：2.876，95%CI（1.120-7.386）]，和HSCT后的几年[OR：1.148，95%CI（1.042-1.266）]，而恶性肿瘤仅在单变量分析中确定。多变量模型具有良好的类分离能力[AUC=72%，95%CI（61.4%-82.4%）]，两名患者患有甲状腺乳头状癌，在接受过TBI的儿童中。
结论：这些数据强调了男性和放疗是导致甲状腺功能减退症风险增加的两个独立因素。此外，甲状腺功能减退症的患病率随着HSCT后时间的延长而增加.
方法：这是一个观察性的，回顾性,单中心队列研究,纳入194例(58.6%为男孩)在同种异体HSCT后存活至少1年的患者。调节方案取决于移植时的诊断和活性方案。一些患者接受了照射，无论是中枢神经系统预防（n=20），或全身照射(TBI)(n=8)。甲状腺评估包括促甲状腺激素，游离甲状腺素,甲状腺自身抗体，还有超声波图.使用单变量和多变量逻辑模型来检查上述因素与甲状腺功能减退症的关联。
结果：诊断和骨髓移植（BMT）的平均年龄分别为7.51±0.46和7.58±0.36。中位随访时间为4.83年。甲状腺功能减退33例(17.7%),其中四名患者接受了TBI。根据多变量分析，导致甲状腺功能减退的因素是男性，[OR：3.005，95%CI（1.145-7.890）]，辐照，[OR：2.876，95%CI（1.120-7.386）]，和HSCT后的几年[OR：1.148，95%CI（1.042-1.266）]，而恶性肿瘤仅在单变量分析中确定。多变量模型具有良好的类分离能力[AUC=72%，95%CI（61.4%-82.4%）]，两名患者患有甲状腺乳头状癌，在接受过TBI的儿童中。
结论：这些数据强调了男性和放疗是导致甲状腺功能减退症风险增加的两个独立因素。此外，甲状腺功能减退症的患病率随着HSCT后时间的延长而增加.
