Hubungan Kadar Ferritin Serum dengan Fungsi Tiroid pada Anak dengan Thalassemia beta Mayor
Sari
Latar belakang. Thalassemia beta mayor merupakan penyakit yang ditandai dengan anemia kronik, hipoksia kronik jaringan, dan pemberian transfusi darah seumur hidup. Penumpukan besi akibat pemberian transfusi berulang berefek toksik pada berbagai organ, termasuk kelenjar tiroid.
Tujuan. Mengetahui hubungan antara kelebihan beban besi dengan kejadian hipotiroid pada anak yang menderita thalassemia beta mayor.
Metode. Penelitian cross-sectional terhadap 43 subjek dengan thalassemia beta mayor dan mendapat transfusi darah rutin pada periode April 2018-Februari 2019. Subjek dipilih secara total sampling dan dikelompokkan berdasarkan kadar ferritin serum <2500 µg/L dan >2500 µg/L. Hasil kadar tiroksin dan thyroid stimulating hormone dikelompokkan menjadi eutiroid dan hipotiroid. Hasil analisis statistik bermakna bila p<0,05.
Hasil. Kadar ferritin serum <2500 µg/L dan >2500 µg/L terdapat pada masing-masing 19 (44,2%) dan 24 (55,8%) subjek. Hipotiroid terjadi pada 13 (38,1%) subjek dengan kadar ferritin >2500 ?g/L dan delapan (38,1%) subjek dengan kadar ferritin <2500 µg/L. Tidak ditemukan hubungan bermakna antara ferritin serum dengan fungsi tiroid pada subjek (p=0,432).
Kesimpulan. Persentase hipotiroid meningkat seiring peningkatan kadar ferritin serum, tetapi tidak terdapat hubungan bermakna antara kadar ferritin serum dengan fungsi tiroid pada anak dengan thalassemia beta mayor.
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Cunningham MJ, Macklin EA, Neufeld EJ, Cohen AR. Complications of beta-thalassemia major in North America. Blood 2004;104:34-9.
Agarwal MB. Advances in management of thalassemia (Editorial). Indian Pediatri 2004;114:1457-66.
Higgs DR, Thein SL, Woods WG. The molecular pathology of the thalassaemias. Dalam: Weatherall DJ, Clegg B, penyunting. The thalassaemia syndromes. Edisi ke-4. England: Blackwell Sci; 2001.h.133-91.
Mengenal thalasemia [Internet]. Indonesia; 2016 [cited 2018 Jan 03]. Didapat dari: http://www.idai.or.id/artikel/seputar-kesehatan-anak/mengenal-thalasemia.
Rund D, Rachmilewitz E. Medical progress: beta-thalassemia. N Engl J Med 2005;353:1135-46.
Hoffbrand AV, Taher A, Cappellini MD. How I treat transfusional iron overload. Blood 2012;120:3657-69.
Vichinsky E, Levine L. Standards of care guidelines for thalassemia. Oakland: Children’s hospital and research center; 2012.h.1-24.
Jacobs A, Beamish MR, Allison M. The measurement of circulating ferritin. J Clin Pathol 1972;25:1003.
Jacobs A, Miller F, Worwood M, Beamish MR, Wardrop CA. Ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Br Med J 1972;4:206-8.
DeSanctis V, Skordis N, Soliman A. Endocrine disease. Dalam: Capellini MD, Cohen A, Taher JPA, Viprakasit V, penyunting.Guidelines for the management of transfusion dependent thalassemia (TDT) 3rd ed. Nicosia: Thalassemia International Federation; 2014.h.146-56.
Shamsirasaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, dkk. Metabolic and endocrinologic complications in beta thalassemia major: A multicenter study in Tehran. BMC Endocrine Disorders 2003;3:23-34.
Tubman VN, Fung EB, Vogiatzi M, Thompson AA, Rogers ZR, Neufeld EJ, dkk. Guidelines for the standard monitoring of patients with thalassemia: report of the thalassemia longitudinal cohort. J Pediatr Hematol Oncol 2015;37:162-9.
Hashemizadeh H, Noori R. Assessment of hypothyroidism in children with beta-thalassemia major in North Eastern Iran. Iranian Journal of Pedaitric Hematol Oncol 2012;2:123-7.
Rindang C, Batubara JRL, Amalia P, Satari H. Some aspects of thyroid dysfunction in thalassemia major patients with severe iron overload. Pediatr Indones 2011;51:66-72.
Merchant RH, Shirodkar A, Ahmed J. Evaluation of growth, puberty and endocrine dysfunctions in relation to iron overload in multi transfused Indian thalassemia patients. Indian J Pediatr 2011;78:679-83.
DeSanctis V. Multicenter study on prevalence of endocrine complications in thalassemia major. Clin Endocrinol 1995;42:581-6.
Zervas A, Katopodi A, Protonotariou A, Livadas S, Karagiorga M, Politis C, dkk. Assessment of Thyroid Function in Two Hundred Patients with b -Thalassemia Major. Thyroid 2002;12:3-6.
Roth C, Pekrun A, Bartz M, Jarry H, Eber S, Lakomek M, dkk. Short stature and failure of pubertal development in thalassaemia major: Evidence for hypothalamic neurosecretory dysfunction of growth hormone secretion and defective pituitary gonadotropin secretion. Eur J Pediatr 1997;156:777-83.
Aydinok Y, Darcan S, Plat A, Kavakili K, Nisli G CM dkk. Endocrine complications in patients with ?-thalassemia major. J Trop Pediatr 2002;48:50-4.
Grundy RG, Woods KA, Savage M, Evans JPM. Relationship of endocrinopathy to iron chelation status in young patients with thalassaemia major. Arch Dis Child 1994;71:128-32.
Panchal R, Patel A. Prevalence of hypothyroidism in children with thalassemia-? major in children coming to the New Civil Hospital, Surat, Gujarat. Int J Med Sci Public Heal 2016;5:2475-8.
Ratih D, Susanto R, Sudarmanto B. Pengaruh deferasirox terhadap kadar T4 dan TSH pada ?-thalassemia mayor dengan kadar ferritin tinggi. Sari Pediatri 2011;12:433-9.
Styne DM. Pediatric endocrinology: A clinical handbook. Switzerland: Springer; 2016.
Verburg FA, Hebestreit H, Steigerwald U, Lentjes EGWM, Ergezinger K, Grelle I, dkk. Reference ranges for analytes of thyroid function in children. Horm Metab Res 2011;43:422-6.
Viprakasit V, Origa R. Genetic basis, pathophysiology and diagnosis. Dalam: Cappellini M, Cohen A, Porter J, Taher A, Viprakasit V, Editors, redakteurs. Guidelines for the management of transfusion dependent thalassaemia (TDT). Nicosia: Thalassemia International Federation; 2014.h.14–25.
Rachmilewitz EA, Giardina PJ. How I treat thalassemia. Blood 2011;118:3479-88.
DeSanctis V, Roos M, Gasser T, Fortini M, Raiola G, Galati MC. Italian working group of endocrine complications in non-endocrine diseases. Impact of long-term iron chelation therapy on growth and endocrine functions in thalassemia. J Pediatr Endocrinol Metab 2006;19:471–80.
DeSanctis V, Soliman A, Campisi S, M MY. Thyroid disorders in thalassaemia: An update. Curr Trends Endocrinol 2012;5:17-27.
Toumba M, Sergis A, Kanaris C, Skordis N. Endocrine complications in patients with thalassemia major. Pediatr Endocrinol Rev 2007;5:642-8.
Chirico V, Antonio L, Vincenzo S, Luca N, Valeria F, Basilia P, dkk. Thyroid dysfunction in thalassaemic patients: ferritin as a prognostic marker and combined iron chelators as an ideal therapy. Eur J Endocrinol 2013;169:785-93.
Thuret I, Pondarré C, Loundou A, Steschenko D, Girot R, Bachir D, dkk. Complications and treatment of patients with beta-thalassemia in France: results of the national registry. Haematologica 2010;95:724-9.
Jaipuria R, R.K. N, Malik R, Shrivastava A, Balani S, Tripathi A. Assessment of thyroid function in children with beta-thalassemia major and its correlation with serum ferritin and transfusion index. J Evol Med Dent Sci 2014;3:847-54.
Olivieri NF, Nathan DG, Macmillan JH, Wayne AS, Liu PP, McGee A, dkk. Survival in medically treated patients with homozygous beta-thalassemia. N Engl J Med 1994;331:574-8.
Porter J, Viprakasit V. Iron overload and chelation. In: Cappellini MD, Cohen AR, Porter J, Taher A, Viprakasit V, penyunting. Guidelines for the management of transfusion dependent thalassaemia (TDT). 3rd ed Nicosia: Thalassemia International Federation; 2014.h.42-75.
Hoffbrand AV, Cohen A, Hershko C. Role of deferiprone in chelation therapy for transfusional iron overload. Blood 2003;102:17-24.
Pirinççio-lu A euGözü, Deniz T, Gökalp D, Beyazit N, Haspolat K, Söker M. Assessment of thyroid function in children aged 1-13 years with beta-thalassemia major. Iran J Pediatr 2011;21:77-82.
Drema L, Singh P, Singh K, Pannu Ms, Kaur M, Neki Ns. Thyroid profile in multi transfused children of beta thalassemia major and its corelation with serum ferritin levels. Int J Curr Res Med Sci 2017;3:14-21.
DOI: http://dx.doi.org/10.14238/sp25.1.2023.27-31
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