Subclinical Hypothyroidism in TAFRO Syndrome

Area of Science:

• Internal Medicine
• Endocrinology
• Rheumatology

Background:

• TAFRO syndrome is a rare disorder with unknown mechanisms and no established therapies.
• Pathological hypercytokinemia, involving vascular endothelial growth factor (VEGF), is a hallmark of TAFRO syndrome.
• Hypothyroidism's clinical significance in TAFRO syndrome remains unclear, despite reported correlations between VEGF and TSH levels.

Purpose of the Study:

• To investigate the relationship between thyroid function, cytokines, and TAFRO syndrome manifestations.
• To understand the clinical significance of thyroid abnormalities in TAFRO syndrome.

Main Methods:

• Detailed examination of thyroid function in six TAFRO syndrome patients.
• Analysis of plasma VEGF levels and correlation with thyroid status.

Main Results:

• Five of six patients presented with subclinical hypothyroidism; one had clinical hypothyroidism.
• All patients exhibited elevated plasma VEGF levels (mean: 256 pg/mL).
• Thyroxine supplementation and immunotherapy/chemotherapy improved TAFRO symptoms and increased VEGF levels in three patients.

Conclusions:

• Subclinical hypothyroidism may contribute to the pathogenesis and symptoms of TAFRO syndrome.
• Elevated VEGF levels are consistently observed in TAFRO syndrome patients with hypothyroidism.
• Thyroid hormone replacement therapy shows potential in managing TAFRO syndrome.