Long-Term Follow-Up of Thyroid Function in Patients Who Received Bone Marrow Transplantation during Childhood and Adolescence

Abstract

An increasing number of long-term surviving bone marrow transplant (BMT) recipients have recovered from their primary disease but are at risk of developing failure of endocrine organs. We investigated 147 patients who underwent allogeneic BMT. Thyroid function was evaluated by serial measurement of basal TSH and free T4 levels as well as by TRH provocative test. Thyroid ultrasound examination was performed for evaluation of thyroid tumor after BMT. Five patients were found to have overt thyroid dysfunction (hypothyroidism in four patients and hyperthyroidism in one patient). Twenty-three patients in the under 9-yr-old group at BMT and 16 patients in the over 10-yr-old group at BMT had subclinical compensated hypothyroidism. Younger age at BMT was the strongest factor for developing thyroid dysfunction, compared with older age (P < 0.001). Only in patients with subclinical compensated hypothyroidism did median basal and peak TSH increase to the upper half of the normal range by 8 yr after BMT and then returned slightly to the middle of the normal range spontaneously. These results suggest that thyroid dysfunction in long-term BMT survivors depends on age at BMT, with a greater risk among younger patients, indicating the need for life-long surveillance.

Late effects in children treated with intensive multimodal therapy for high-risk neuroblastoma: High incidence of endocrine and growth problems

“…[24][25][26] The higher rate may be due to treatment at younger age as supported by data from Ishiguro et al 27 and/or due to damage from diagnostic 131 I-MIBG in spite of potassium iodide prophylaxis. 23 While MIBG scans can cause transient hypothyroidism and could have inflated the numbers depending on when thyroid function was checked, permanent thyroid dysfunction is likely a real finding as the rates in the group 10-15 years from treatment were almost double that of the other groups.…”

Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence

“…Socie et al 32 reported an incidence of 0.2% of thyroid carcinoma among 3182 children after BMT, with a strong relationship between the occurrence of thyroid cancer and age at BMT. Ishiguro et al 28 reported a high incidence of thyroid adenoma after BMT. However, we found only one case of thyroid tumor (papillary carcinoma) in a patient who underwent BMT at age 14.5 years.…”

“…This difference may have been due to our previous policy of performing thyroid ultrasound only in patients with palpable thyroid nodules or suspicious consistency of the thyroid gland, and in patients treated with neck or mediastinal irradiation. By contrast, Ishiguro et al 28 performed thyroid ultrasound annually in many of their patients. Our new suggested surveillance approach includes thyroid palpation with performance of thyroid ultrasound in patients with a suspicious consistency of the thyroid gland, or annually in patients after neck, thoraco-mediastinal irradiation or TBI.…”

“…Three patients (3.3%) were diagnosed with type II diabetes mellitus and three (3.3%) with IGT at a mean age of 21.576.1 years (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. A BMI-SDS of o2 was noted in all three patients with diabetes and in two of the three patients with IGT.…”

“…28 The most common type of thyroid dysfunction in long-term survivors of BMT is subclinical compensated or overt hypothyroidism, whose frequency seems to be related to the use of the conditioning therapy, including TBI. Although hypothyroidism is usually a relatively early complication of BMT, it can also manifest years later.…”