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Assessment of thyroid function in children aged 1-13 years with Beta-thalassemia major
Ayfer Gözü Pirinççioğlu1, Turgay Deniz, Deniz Gökalp
1Department of Pediatrics, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.
Insights
Hypothyroidism can occur in children with beta-thalassemia major during their first decade of life, contrary to previous assumptions. This is linked to significantly higher iron overload in these patients.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Metabolic Disorders
Background:
- Beta-thalassemia major is a genetic blood disorder requiring lifelong transfusions.
- Iron overload is a common complication in beta-thalassemia major patients.
- Hypothyroidism is often associated with iron overload and typically appears later in life.
Purpose of the Study:
- To investigate thyroid dysfunction in children with beta-thalassemia major.
- To determine if hypothyroidism occurs earlier in life in these patients.
- To assess the relationship between iron overload and thyroid function.
Main Methods:
- Evaluated thyroid function (FT4, FT3, T3, T4, TSH) and ferritin levels in 90 children with beta-thalassemia major.
- Compared patient thyroid parameters and ferritin levels to an age-sex matched healthy control group.
- Administered thyrotropin-releasing hormone tests to patients with elevated TSH.
Main Results:
- Patients with beta-thalassemia major exhibited significantly higher serum ferritin levels compared to controls.
- Most thyroid function tests were within normal ranges, but three patients showed elevated TSH levels.
- Elevated TSH levels indicated subclinical primary hypothyroidism in affected patients.
Conclusions:
- Hypothyroidism can manifest in the first decade of life in beta-thalassemia major patients.
- Early-onset hypothyroidism in this population may occur despite advancements in hematological care.
- Iron overload is a critical factor to monitor for thyroid health in pediatric beta-thalassemia major.
Objective:
Hypothyroidism usually appears in the second decade of life and is thought to be associated with iron overload in patients with thalassemia major. This study aimed to evaluate thyroid dysfunctions in patients with beta-thalassemia major and to see if they appear in the earlier period of life.
Methods:
Thyroid function and iron load status were evaluated in 90 children with a mean age of 7.17±3.78 years with beta-thalassemia major by measuring serum free thyroxin (FT4), serum free triiodothyronine (FT3), total thyroxin (T3), serum total triiodothyronine (T4), thyroid-stimulating hormone (TSH) and ferritin levels from serum of patients admitted to the Pediatric Department, Faculty of Medicine University of Dicle between March 2005 and July 2009. A control group formed from an age-sex matched healthy children with a mean age of 6.98±3.66 years was also included. A standard thyrotropin releasing hormone test was applied to 3 patients who had high TSH levels and were classified as subclinical primer hypothyroidism. The study was designed according to the Declaration of Helsinki and informed consent was obtained from the parents of all participants.
Findings:
All thyroid parameters in patients were in the normal ranges compared with the controls except three of them which had high TSH levels. Serum ferritin level (2703±1649 ng/mL) in patients was significantly higher than in controls (81.5±15.5 ng/mL).
Conclusion:
The work implies that hypothyroidism could be even seen in the first decade of life in patients with beta-thalassemia major in spite of improved hematological cares.
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