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目的:分析骨髓移植后引起甲状腺功能亢进的病因、临床特点、治疗及预后。方法:报道1例慢性髓性白血病患者非血缘供者骨髓移植术后并发甲状腺功能亢进随访9年的结果,并复习相关文献。结果:患者男性,21岁,确诊慢性髓性白血病后行非血缘供者骨髓移植,术后+44天,出现持续低热,抗细菌、抗病毒及抗真菌治疗均无效,排除疾病复发,查甲状腺功能提示患者从亚临床甲状腺功能亢进进展为甲状腺功能亢进,给予口服甲巯咪唑治疗2周,患者体温降至正常,血T4、fT4恢复正常,随访9年,慢性髓性白血病无复发,甲状腺功能持续正常。检索文献发现类似报道5例,对其进行归纳分析。结论:骨髓移植术后早期并发甲状腺功能亢进,可能与放化疗预处理及免疫损伤引起的破坏性甲状腺炎相关,有其独特的临床表现,极易被忽视,治疗方面可以尝试应用糖皮质激素及抗甲状腺药物。对于非血缘供者骨髓移植后不明原因发热者,应考虑到甲亢可能。
Objective: To analyze the etiology, clinical features, treatment and prognosis of hyperthyroidism after bone marrow transplantation. Methods: One year follow-up of 9 years of follow-up of hyperthyroidism after bone marrow transplantation in one non-donor with chronic myeloid leukemia was reviewed and relevant literature was reviewed. Results: The male patient, aged 21 years old, had a non-donor bone marrow transplant after diagnosis of chronic myelogenous leukemia. Continuous low fever occurred after +44 days postoperatively. Anti-bacterial, anti-virus and antifungal therapy were ineffective, Functional tips Patients from hypothyroidism hyperthyroidism progress to hyperthyroidism, given oral methimazole treatment for 2 weeks, the patient’s temperature dropped to normal, blood T4, fT4 returned to normal, followed up for 9 years, no recurrence of chronic myeloid leukemia, thyroid function Continued normal. Retrieval literature found similar reports of 5 cases, its induction. Conclusion: The early posttransplantation of hyperthyroidism may be related to the pretreatment of radiotherapy and chemotherapy and the destructive thyroiditis caused by immune injury. It has its unique clinical manifestations and can easily be neglected. In the treatment, we can try glucocorticoid and Antithyroid drugs. For non-blood donor donor bone marrow transplant fever of unknown origin, should take into account the possibility of hyperthyroidism.