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Incidencia de trastornos de la función tiroidea e hipogonadismo en pacientes con trasplante de progenitores hematopoyéticos en un centro médico de Floridablanca – Santander - Colombia en el período 2009-2019
dc.contributor.advisor | Wandurraga Sánchez, Edwin Antonio | |
dc.contributor.advisor | Sossa Melo, Claudia Lucía | |
dc.contributor.advisor | Ochoa Vera, Miguel Enrique | |
dc.contributor.author | Arias Ariza, Reinaldo Ferney | |
dc.coverage.spatial | Floridablanca (Santander, Colombia) | spa |
dc.coverage.temporal | 2009-2019 | spa |
dc.date.accessioned | 2021-08-19T22:16:14Z | |
dc.date.available | 2021-08-19T22:16:14Z | |
dc.date.issued | 2021 | |
dc.identifier.uri | http://hdl.handle.net/20.500.12749/13927 | |
dc.description.abstract | Introducción: El trasplante de progenitores hematopoyéticos (TPH) es la mejor estrategia de consolidación en el manejo de pacientes con neoplasias hematolinfoides y algunas enfermedades autoinmunes. Aunque estudios previos reportan que el TPH se asocia a alteraciones endocrinas, definir la incidencia de trastornos tiroideos e hipogonadismo en nuestro entorno permitirá plantear ajustes al régimen de acondicionamiento y seguimiento post TPH. Materiales y métodos: Se realizó un análisis secundario de una base de datos de pacientes mayores de 18 años sometidos a TPH (2009-2019), sin enfermedad tiroidea o hipogonadismo. Además de la extracción de variables clínicas, se hizo un análisis pre y post trasplante (1y 3 años) de los niveles de FSH, testosterona, TSH y T4L. Se estimó la incidencia general y entre subgrupos según la intensidad del régimen de acondicionamiento y otras variables sociodemográficas, clínicas y relacionadas al TPH. Resultados: Encontramos una incidencia acumulada de hipotiroidismo a 1 y 3 años posterior al trasplante del 18 % y 40.3 % respectivamente; mientras que la incidencia de hipertiroidismo a 1 y 3 años pos TPH fue del 6.6 % y 12.8 % correspondientemente. Con respecto a la función gonadal se documentó una incidencia de hipogonadismo masculino a 1 año del 28.6 % usando punto de corte de testosterona menor a 300 ng/dl y una incidencia de insuficiencia ovárica temprana en este mismo período de seguimiento del 62.5 %. El 70.9 % de los TPH fueron autólogos y no se encontró asociación entre el empleo de regímenes de acondicionamiento mieloablativos y la incidencia de trastornos de la función tiroidea o hipogonadismo. Se documentó el nivel normal-alto de TSH (2.5-4.2 mU/L) pre trasplante como un factor asociado con mayor riesgo de desarrollar hipotiroidismo en el período pos TPH. Conclusiones: La alta incidencia de los trastornos de la función tiroidea y gonadal en pacientes llevados a TPH, hace necesario la búsqueda sistemática de dichos trastornos mediante un seguimiento clínico y bioquímico adecuado. La fisiopatología compleja de los trastornos endocrinos asociados al TPH plantea la necesidad de estudios subsiguientes que contribuyan a dilucidar mejor este proceso y con ello mejorar las estrategias de prevención y diagnóstico temprano. | spa |
dc.description.tableofcontents | Listado de tablas………………………………………………………………………………………………………………..8 Listado de figuras………………………………………………………………………………………………………………9 Resumen y palabras clave………………………………………………………………………………………………….10 1. Justificación y planteamiento del problema………………………………………………………………………14 2. Marco teórico……………………………………………………………………………………………………………………16 2.1 Trasplante de precursores hematopoyéticos…………………………………………………………………….16 2.2 Disfunción tiroidea e hipogonadismo asociados al TPH y el tratamiento para el cáncer……17 3. Estado del arte………………………………………………………………………………………………………………….19 4. Objetivos…………………………………………………………………………………………………………………………..21 4.1 Objetivo general……………………………………………………………………………………………………………….21 4.2 Objetivos específicos…………………………………………………………………………………………………………21 5. Hipótesis…………………………………………………………………………………………………………………………...22 6. Metodología…………………………………………………………………………………………………………………..…23 6.1 Diseño……………………………………………………………………………………………………………………………….23 6.2 Universo……………………………………………………………………………………………………………………………23 6.3 Población y muestra………………………………………………………………………………………………………….23 6.4 Criterios de elegibilidad…………………………………………………………………………………………………….24 6.4.1 Criterios de inclusión…………………………………………………………………………………………………..24 6.4.2 Criterios de exclusión………………………………………………………………………………………………….24 6.5 Variables…………………………………………………………………………………………………………………………..24 6.6 Recolección de datos………………………………………………………………………………………………………..33 6.7 Plan de análisis de datos…………………………………………………………………………………………………..34 7. Consideraciones éticas……………………………………………………………………………………………………..35 8. Resultados………………………………………………………………………………………………………………………..36 9. Discusión…………………………………………………………………………………………………………………………..50 10. Fortalezas y limitaciones…………………………………………………………………………………………………..57 11. Conclusiones…………………………………………………………………………………………………………………….58 12. Anexos……………………………………………………………………………………………………………………………..59 13. Referencias bibliográficas…………………………………………………………………………………………………62 | spa |
dc.format.mimetype | application/pdf | spa |
dc.language.iso | spa | spa |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/2.5/co/ | * |
dc.title | Incidencia de trastornos de la función tiroidea e hipogonadismo en pacientes con trasplante de progenitores hematopoyéticos en un centro médico de Floridablanca – Santander - Colombia en el período 2009-2019 | spa |
dc.title.translated | Incidence of thyroid function disorders and hypogonadism in patients with hematopoietic stem cell transplantation in a medical center in Floridablanca - Santander - Colombia in the period 2009-2019 | spa |
dc.degree.name | Especialista en Medicina Interna | spa |
dc.publisher.grantor | Universidad Autónoma de Bucaramanga UNAB | spa |
dc.rights.local | Abierto (Texto Completo) | spa |
dc.publisher.faculty | Facultad Ciencias de la Salud | spa |
dc.publisher.program | Especialización en Medicina Interna | spa |
dc.description.degreelevel | Especialización | spa |
dc.type.driver | info:eu-repo/semantics/masterThesis | |
dc.type.local | Tesis | spa |
dc.type.coar | http://purl.org/coar/resource_type/c_bdcc | |
dc.subject.keywords | Internal medicine | spa |
dc.subject.keywords | Medicine | spa |
dc.subject.keywords | Medical sciences | spa |
dc.subject.keywords | Health sciences | spa |
dc.subject.keywords | Hematopoietic stem cell transplantation | spa |
dc.subject.keywords | Hypothyroidism | spa |
dc.subject.keywords | Hyperthyroidism | spa |
dc.subject.keywords | Hypogonadism | spa |
dc.subject.keywords | Early ovarian failure | spa |
dc.subject.keywords | Endocrine glands | spa |
dc.subject.keywords | Hormones | spa |
dc.subject.keywords | Neoplasms | spa |
dc.subject.keywords | Autoimmune diseases | spa |
dc.identifier.instname | instname:Universidad Autónoma de Bucaramanga - UNAB | spa |
dc.identifier.reponame | reponame:Repositorio Institucional UNAB | spa |
dc.type.hasversion | info:eu-repo/semantics/acceptedVersion | |
dc.rights.accessrights | info:eu-repo/semantics/openAccess | spa |
dc.rights.accessrights | http://purl.org/coar/access_right/c_abf2 | spa |
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dc.contributor.cvlac | Wandurraga Sánchez, Edwin Antonio [0001475567] | spa |
dc.contributor.cvlac | Sossa Melo, Claudia Lucía [0001425704] | spa |
dc.contributor.cvlac | Ochoa Vera, Miguel Enrique [0000898465] | spa |
dc.contributor.googlescholar | Sossa Melo, Claudia Lucía [n1PL8iUAAAAJ&hl=es&oi=ao] | spa |
dc.contributor.orcid | Ochoa Vera, Miguel Enrique [0000-0002-4552-3388] | spa |
dc.contributor.researchgate | Wandurraga Sánchez, Edwin Antonio [Edwin-Antonio-Wandurraga-Sanchez-2168480303] | spa |
dc.contributor.researchgate | Sossa Melo, Claudia Lucía [Claudia-Sossa] | spa |
dc.contributor.researchgate | Ochoa Vera, Miguel Enrique [Miguel-Enrique-Ochoa-2186675588] | spa |
dc.subject.lemb | Medicina interna | spa |
dc.subject.lemb | Medicina | spa |
dc.subject.lemb | Ciencias médicas | spa |
dc.subject.lemb | Glándulas endocrinas | spa |
dc.subject.lemb | Hormonas | spa |
dc.subject.lemb | Neoplasmas | spa |
dc.subject.lemb | Enfermedades autoinmunes | spa |
dc.identifier.repourl | repourl:https://repository.unab.edu.co | spa |
dc.description.abstractenglish | Introduction: Hematopoietic stem cell transplantation (HSCT) is the best consolidation strategy in the management of patients with hematolymphoid neoplasms and some autoimmune diseases. Although previous studies report that HSCT is associated with endocrine alterations, defining the incidence of thyroid disorders and hypogonadism in our setting will allow for adjustments to the conditioning regimen and post HSCT follow-up. Materials and methods: A secondary analysis of a database of patients over 18 years of age who underwent HSCT (2009-2019), without thyroid disease or hypogonadism, was carried out. In addition to the extraction of clinical variables, a pre and post transplant analysis (1 and 3 years) of FSH, testosterone, TSH and FT4 levels was performed. The general incidence and between subgroups were estimated according to the intensity of the conditioning regimen and other sociodemographic, clinical and HSCT-related variables. Results: We found a cumulative incidence of hypothyroidism 1 and 3 years after transplantation of 18% and 40.3% respectively; while the incidence of hyperthyroidism at 1 and 3 years after HSCT was 6.6% and 12.8% correspondingly. Regarding gonadal function, a 28.6% incidence of male hypogonadism at 1 year was documented using a testosterone cut-off point of less than 300 ng / dl and an incidence of early ovarian failure in this same follow-up period of 62.5%. 70.9% of HSCT were autologous and no association was found between the use of myeloablative conditioning regimens and the incidence of disorders of the lung. thyroid function or hypogonadism. The normal-high level of TSH (2.5-4.2 mU / L) before transplantation was documented as a factor associated with a higher risk of developing hypothyroidism in the post-HSCT period. Conclusions: The high incidence of thyroid and gonadal function disorders in patients undergoing HSCT, makes It is necessary to systematically search for these disorders through adequate clinical and biochemical follow-up. The complex pathophysiology of endocrine disorders associated with HSCT raises the need for subsequent studies that contribute to better elucidate this process and thereby improve prevention and early diagnosis strategies. | spa |
dc.subject.proposal | Ciencias de la salud | spa |
dc.subject.proposal | Trasplante de progenitores hematopoyéticos | spa |
dc.subject.proposal | Hipotiroidismo | spa |
dc.subject.proposal | Hipertiroidismo | spa |
dc.subject.proposal | Hipogonadismo | spa |
dc.subject.proposal | Insuficiencia ovárica temprana | spa |
dc.type.redcol | http://purl.org/redcol/resource_type/TM | |
dc.rights.creativecommons | Atribución-NoComercial-SinDerivadas 2.5 Colombia | * |
dc.coverage.campus | UNAB Campus Bucaramanga | spa |
dc.description.learningmodality | Modalidad Presencial | spa |