BackgroundThe combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients. The main objective of this study is to determine the prevalence of prominent thalassemia complications.MethodsTwo hundred twenty patients entered the study. Physicians collected demographic and anthropometric data and the history of therapies as well as menstrual histories. Patients have been examined to determine their pubertal status. Serum levels of 25(OH) D, calcium, phosphate, iPTH were measured. Thyroid function was assessed by T3, T4 and TSH. Zinc and copper in serum were determined by flame atomic absorption spectrophotometry. Bone mineral density (BMD) measurements at lumbar and femoral regions have been done using dual x-ray absorptiometry. The dietary calcium, zinc and copper intakes were estimated by food-frequency questionnaires.ResultsShort stature was seen in 39.3% of our patients. Hypogonadism was seen in 22.9% of boys and 12.2% of girls. Hypoparathyroidism and primary hypothyroidism was present in 7.6% and 7.7% of the patients. About 13 % of patients had more than one endocrine complication with mean serum ferritin of 1678 ± 955 micrograms/lit. Prevalence of lumbar osteoporosis and osteopenia were 50.7% and 39.4%. Femoral osteoporosis and osteopenia were present in 10.8% and 36.9% of the patients. Lumbar BMD abnormalities were associated with duration of chelation therapy. Low serum zinc and copper was observed in 79.6% and 68% of the study population respectively. Serum zinc showed significant association with lumbar but not femoral BMD. In 37.2% of patients serum levels of 25(OH) D below 23 nmol/l were detected.ConclusionHigh prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.

With regard to recent recommendations, we also suggest PPI, amoxicillin and clarithromycin triple therapy as a first-line eradication treatment, and quadruple therapies as a second-line option, in Iranian children.

This study sought a possible relationship between pre-eclampsia and thyroid profile. In a case-control setting, total thyroxine (T4), total tri-iodothyronine (T3), free T4, free T3, thyroxine binding globulin (TBG) and thyrotropin (TSH) levels in 39 pre-eclamptic patients were measured and compared with the levels in 42 healthy controls. We examined possible variations with regard to the severity of pre-eclampsia by dividing cases into mild (n = 17) and severe (n = 22) subgroups. Patients with mild pre-eclampsia showed significantly increased free T4 and TSH levels compared to healthy controls. In severe cases, TSH level was higher, but free T3 and free T4 levels were significantly lower than in controls. Other tests returned non-significant differences between the groups. Our findings suggest that primary hypofunctioning of the thyroid can accompany mild pre-eclampsia and possibly contribute to the pathogenesis. Elevated levels of free thyroid hormones in severe cases, however, may have reflected a preceding thyroid disorder.

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