Thyroid Dysfunction in Adult Long-term Survivors After Hemapoeitic Stem-cell Transplantation (HSCT)

Abstract

Thyroid function was evaluated in 72 adult survivors (41 females and 31 males) at 16 to 56 years of age, 1.5 years mean time (range 0.2 - 9.8) after hemapoeitic stem cell transplantation (HSCT) with no known prior history of thyroid dysfunction. Thyroid stimulating hormone (TSH) and free thyroxin levels (FT4) were determined before and after stimulation with thyrotropin releasing hormone (TRH). Conditioning regimens for HSCT did not include TBI. Overt hypothyroidism (basal TSH > 8 microIU/ml, FT4 < 0.8 ng/dl) was observed in 6% of male patients and 5% of female patients; subclinical hypothyroidism (basal TSH 4 - 8 microIU/ml, low normal FT4 0.8 - 1.9 ng/dl) was observed in 13% of males and 5% of females. A significant number of euthyroid patients (40% males and 54% females) with normal basal TSH and FT4 levels overresponded to TRH stimulation; the finding being statistically significant (p < 0.005). A heavy TSH response after TRH stimulation indicates compensated subclinical dysfunction of the thyroid gland. Chemotherapy-only conditioning regimens may have an adverse effect on thyroid gland function not always detected by determination of basal TSH and FT4 levels. This finding warrants long-term evaluation of thyroid function in HSCT patients.

Thyroid dysfunction in adult patients late after autologous and allogeneic blood and marrow transplantation

“…1 The occurrence of thyroid dysfunction (TDF) as a complication of BMT and the factors associated with it have been described primarily in pediatric recipients of allogeneic BMT. [2][3][4] However, fewer studies have analyzed the incidence of this complication in adults, [5][6][7] in particular after autologous BMT. 5 In this study, we retrospectively analyzed the incidence of TDF in all consecutive adult BMT recipient survivors from our center for whom serial monitoring of thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were available (n ¼ 169 adults; Table 1).…”

“…[2][3][4] However, fewer studies have analyzed the incidence of this complication in adults, [5][6][7] in particular after autologous BMT. 5 In this study, we retrospectively analyzed the incidence of TDF in all consecutive adult BMT recipient survivors from our center for whom serial monitoring of thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were available (n ¼ 169 adults; Table 1). This population is representative of the overall BMT population for the same period (February 1993-April 2008) in terms of patient and transplant characteristics, such as type of BMT (autologous vs allogeneic), type of allogeneic donor (related vs unrelated), type of conditioning for allogeneic BMT (myeloablative vs non-myeloablative), gender, age at BMT, underlying disease and source of progenitors (data not shown).…”

“…This negative finding in Somali's study is not surprising if we take into consideration both the lower number of cases included in the study (29 autologous and 43 allogeneic) and their shorter follow-up time of only 1.5 years, considering our findings on the late onset of TDF after autologous BMT. 5 Other than type of BMT, we found no statistically significant association in adult long-term BMT survivors between TDF and patient or transplant characteristics such as age, gender, underlying disease, hematopoietic cell source, type of conditioning for allogeneic BMT, type of allogeneic donor and exposure to radiotherapy, either as TBI for conditioning (X12 Gy divided into four fractions in all cases) or as any radiation exposure including pretransplant radiotherapy involving the thyroid gland in 12 additional lymphoma patients (Table 1). TBI has been clearly linked to the occurrence of TDF after BMT in a large series of 791 children.…”

“…[5][6][7] These studies focused on allogeneic BMT, and only one of them, by Somali et al, 5 included cases of autologous BMT, showing no difference in their incidence of TDF compared with their allogeneic BMT counterparts. This negative finding in Somali's study is not surprising if we take into consideration both the lower number of cases included in the study (29 autologous and 43 allogeneic) and their shorter follow-up time of only 1.5 years, considering our findings on the late onset of TDF after autologous BMT.…”

Treatment Related Hypothyroidism, a Viewpoint from Cancer Therapy and Hematopoietic Stem Cell Transplantation

“…Case studies have shown that a donor with autoimmune thyroid disorder may transfer cell capable of injuring the recipient's thyroid gland after hematopoietic stem cell transplantation (Lee et al 2001;Marazuela, and Steegman 2000). Immune-mediated thyroid injury arising in the host has been suggested in other studies and may be a form of graftversus-host-disease (Kami et al 2001;Katsanis et al 1990;Somali et al 2005). Patients receiving single-agent graft-versus-host-disease prophylaxis were found to have a 9.5 times greater risk of developing hypothyroidism than patients with multi-agent prophylaxis (Katsanis et al 1990).…”