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  • Title: THYROID DISEASE IN THE LATE OBSERVATION PERIOD UPON CHEMO AND RADIOTHERAPY IN CHILDREN/SURVIVORS OF ACUTE LYMPHOBLASTIC LEUKEMIA.
    Author: Bebeshko VG, Bruslova KM, Lyashenko LO, Tsvіetkova NM, Galkina SG, Yaroshenko ZS, Gonchar LO, Boyarska OY, Kuzmenko VF, Trykhlib IV, Kavardakova NV.
    Journal: Probl Radiac Med Radiobiol; 2021 Dec; 26():309-318. PubMed ID: 34965557.
    Abstract:
    OBJECTIVE: to assess the thyroid disease in the late observation period in children who had received chemo- andradiotherapy for the acute lymphoblastic leukemia (ALL) taking into account gender, age period and disease sub-type. MATERIALS AND METHODS: The incidence and nature of thyroid disease (hypothyroidism, thyroiditis, and thyroid can-cer) were studied in children-survivors of acute lymphoblastic leukemia (ALL) being in remission from 6 to 25 years.The distribution of patients by leukemia subtypes was as follows: «common» - 67.4 %, pre-B - 23.9 %, pro-B andT-cell - 4.3 %. Children had been receiving chemo- and radiotherapy according to the protocol. Regarding the ageof patients at the time of ALL diagnosis the prepubertal, pubertal and postpubertal periods were taken into account.The endocrine diseases in family history, body weight at birth, serum content of free thyroxine, pituitary thyroid-stimulating hormone, cortisol, iron, ferritin and thyroperoxidase antibodies were evaluated and assayed. RESULTS: Thyroid disease in children was emerging in the first 2-3 years after the ALL treatment with an incidenceof 22.8 % (hypothyroidism - 14.1 %, autoimmune thyroiditis - 7.6 %, papillary cancer - 1.1 %). Seven children inthis group had received radiotherapy (12-18 Gy doses) on the central nervous system (CNS). No correlation wasfound between the radiation exposure event itself, radiation dose to the CNS and thyroid disease in the long-termfollow-up period. Thyroid cancer had developed in a child 11 years upon chemo- and radiotherapy. Hypothyroidismwas more often diagnosed in the patients of prepubertal age (rs = 0.49). There were endocrine diseases in thefamily history in about a half of children, being significantly higher than in the general sample (р < 0.05). The bodyweight at birth of a child who had later developed hypothyroidism was less than in children having got thyroiditis(rs = 0.57). CONCLUSIONS: Disorders in endocrine regulation and of thyroid in particular can affect the prognosis of blood can-cer course in the long-term follow-up in children, especially in prepubertal age, which requires systematic supervi-sion by hematologist and endocrinologist. Meta: otsinyty patologiiu shchytopodibnoï zalozy u diteĭ, iaki otrymuvaly khimio- ta promenevu terapiiu z pryvodugostroï limfoblastnoï leĭkemiï, u viddalenomu periodi sposterezhennia z urakhuvanniam stati, vikovoï periodyzatsiïta variantiv khvoroby.Materialy i metody. U 92 diteĭ z gostroiu limfoblastnoiu leĭkemiieiu, iaki znakhodiat'sia v remisiï vid 6 do 25 rokiv,vyvchaly chastotu ta kharakter patologiï shchytopodibnoï zalozy (gipotyreoz, tyreoïdyt, rak). Rozpodil khvorykh zavariantamy leĭkemiĭ buv takyĭ: «zagal'nyĭ» typ – 67,4 %, pre-V – 23,9 %, pro-V ta T-klitynnyĭ po 4,3 %. Dityotrymuvaly khimio- ta promenevu terapiiu zgidno z protokolom. Shchodo viku khvorykh na chas vstanovlennia diagnozugostroï limfoblastnoï leĭkemiï, to vrakhovuvaly prepubertatnyĭ, pubertatnyĭ ta pislia pubertatnyĭ periody.Otsiniuvaly endokrynni khvoroby v rodovodi, masu tila pry narodzhenni dytyny, vmist vil'nogo tyroksynu, tyre-otropnogo gormonu gipofizu, kortyzolu, zaliza ta ferytynu i antytila do tyreoperoksydazy v syrovattsi krovi. Rezul'taty. Patologiia shchytopodibnoï zalozy u diteĭ vynykala v pershi 2–3 roky pislia kursu terapiï i stanovyla22,8 % (gipotyreoz – 14,1 %, autoimunnyĭ tyreoïdyt – 7,6 %, papiliarnyĭ rak – 1,1 %). Semero diteĭ tsiieï grupyproĭshly promenevu terapiiu v dozakh 12–18 Gr na tsentral'nu nervovu systemu. Ne bulo vstanovleno kore-liatsiĭnogo zv’iazku mizh faktom oprominennia, dozoiu promenevogo navantazhennia na tsentral'nu nervovu systemu ipatologiieiu shchytopodibnoï zalozy u viddalenyĭ period sposterezhennia. Rak shchytopodibnoï zalozy rozvyvsia u dy-tyny cherez 11 rokiv pislia khimio- ta promenevoï terapiï. Gipotyreoz chastishe diagnostuvavsia u khvorykh prepuber-tatnogo viku (rs = 0,49). U polovyny diteĭ v rodovodi bula endokrynna patologiia, shcho virogidno vyshche, nizh u za-gal'niĭ vybirtsi (r < 0,05). Masa tila pry narodzhenni dytyny, u iakoï v podal'shomu rozvynuvsia gipotyreoz bulamenshoiu, nizh u diteĭ z tyreoïdytamy (rs = 0,57). Vysnovky. Zminy v endokrynniĭ reguliatsiï organizmu, zokrema shchytopodibniĭ zalozi, mozhut' vplyvaty na prognozperebigu zloiakisnykh zakhvoriuvan' systemy krovi u diteĭ, osoblyvo prepubertatnogo viku, u viddalenomu periodisposterezhennia, shcho potrebuie systematychnogo nagliadu likaria gematologa ta endokrynologa.
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