Thyroid dysfunction in adult hematopoietic cell transplant survivors: risks and outcomes

Akkuş

Clinical Transplantation

et al. 2020

Introduction Thyroid dysfunction (TD) is one of the major endocrinopathies shown after allogeneic hematopoietic stem cell transplantation over the long term. The incidence and the risk factors for TD have varied widely. Patients and Methods Two hundred and fifty‐nine patients with pre‐transplant normal thyroid function tests who survived at least 1 year after allo‐HSCT between 2006‐2016 were included in the study. Results Sixty‐four patients (25%) developed TD at median of 34 months (range, 1‐112 months). Hypothyroidism was detected in 32 patients (12%): 5 patients had primary hypothyroidism, and subclinical hypothyroidism occurred in 27 patients. 18 patients (7%) were diagnosed with hyperthyroidism: 2 patients (0.07%) were treated for primary hyperthyroidism, and 16 patients (6%) were followed for subclinical hyperthyroidism. Euthyroid sick syndrome occurred in 14 cases. None of the patients with thyroid dysfunction developed secondary thyroid malignancy. Receiving high‐dose TBI (P = .001) was found to be significant risk for hypothyroidism; older age than median (P = .01) and pre‐transplant active disease (P < .0001) were related to hyperthyroidism. Conclusions Thyroid dysfunction, mostly hypothyroidism, is a long‐term complication after allo‐HSCT in 25% of patients. Older age, pre‐transplant active disease, and receiving TBI are among the risk factors. Sustained long‐term monitoring of thyroid function test should be considered post allo‐HSCT.

Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 47%

Thyroid dysfunctions in adult patients after allogeneic hematopoietic stem cell transplantation

Akkuş

Clinical Transplantation

et al. 2020

“…In addition, most studies have assessed the cumulative incidence of TSH deficiency among transplanted patients, irrespectively of the previous exposure to prophylactic cranial or cranio-spinal irradiation delivered as a front-line treatment, hence not allowing authors to draw ultimate conclusions about the specific detrimental role of low dosimetry delivered by TBI upon hypothalamic-pituitary function ( 26 , 47 ). Studies that excluded patients exposed to cranial radiotherapy prior to TBI reported cumulative incidence of central hypothyroidism as low as 0% ( 48 , 49 ).…”

Section: Thyroid Dysfunction and Autoimmune Disordersmentioning

confidence: 99%

Thyroid function disorders and secondary cancer following haematopoietic stem cell transplantation in pediatrics: State of the art and practical recommendations for a risk-based follow-up

et al. 2022

Thyroid disorders (TD) represent a remarkable share of all the late morbidities experienced following pediatric haematopoietic stem cell transplantation (HSCT), with long-term reported occurrence often exceeding 70%. In addition, the data collected on wide cohorts of survivors assessed longitudinally outlined a progressive increase in the cumulative incidence of TD as far as 30 years following transplantation. Accordingly, a life-long monitoring of thyroid health is warranted among patients exposed to HSCT in childhood, in order to early detect TD and undertake a prompt dedicated treatment. Although several national and international consortia have provided recommendations for the early detection of thyroid disorders among childhood cancer survivors exposed to radiotherapy and alkylating agents, no guidelines specifically and thoroughly focused on HSCT-related TD have been published to date. As stem cell transplantation has become the standard-of-care in a growing body of non-oncological conditions, this urge has become pivotal. To highlight the challenging issues specifically involving this cohort of patients and to provide clinicians with the proposal of a practical follow-up protocol, we reviewed published literature in the light of the shared experience of a multidisciplinary team of pediatric oncologists, transplantologists, pathologists and endocrinologists involved in the long-term care of HSCT survivors. As a final result, we hereby present the proposals of a practical and customized risk-based approach to tailor thyroid health follow-up based on HSCT-related detrimental factors.

“…Other endocrine glands are also affected due to total body irradiation. Decreases in gonadotropic hormones release, hyperprolactinemia, secondary infertility, and abnormal steroid hormones secretion are also consequences of irradiation of the hypothalamic and pituitary areas [54,55].…”

Section: Irradiationmentioning

confidence: 99%

A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment

et al. 2021

Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.