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Impact of allogeneic stem cell transplantation on thyroid function.

F Felicetti1,2, F Gatti3,4, D Faraci5

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Hypothyroidism is a common endocrine complication after allogeneic stem cell transplantation (allo-SCT), affecting approximately 18.3% of adult recipients. Higher pre-transplant TSH levels are a key predictor of developing this condition post-transplant.

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Area of Science:

  • Endocrinology
  • Hematology
  • Oncology

Background:

  • Primary hypothyroidism is a frequent endocrine complication following allogeneic stem cell transplantation (allo-SCT) in pediatric populations.
  • Data regarding the incidence and risk factors of post-allo-SCT hypothyroidism in adults remain limited.

Purpose of the Study:

  • To determine the prevalence of hypothyroidism in adult allo-SCT recipients.
  • To identify potential risk factors associated with the development of hypothyroidism after allo-SCT.
  • To analyze the relationship between hypothyroidism and time elapsed since transplantation.

Main Methods:

  • An observational, cross-sectional study involving 186 adult allo-SCT recipients transplanted between January 2010 and December 2017.
  • Patients were stratified into three groups based on time post-allo-SCT: 1-3 years, 3-5 years, and >5 years.
  • Thyroid-stimulating hormone (TSH), free thyroxine (fT4), and anti-thyroperoxidase antibodies (TPO-Ab) were measured pre- and post-transplantation.

Main Results:

  • A total of 34 patients (18.3%) developed hypothyroidism post-allo-SCT.
  • Hypothyroidism was more prevalent in females and in recipients of matched unrelated donor grafts.
  • Higher pre-transplant TSH levels (median 2.34 µU/ml) and TPO-Ab positivity were associated with increased risk.
  • A pre-SCT TSH cutoff of 1.84 µU/ml predicted hypothyroidism with 74.1% sensitivity and 67.2% specificity.

Conclusions:

  • Approximately one in four adult allo-SCT recipients develop hypothyroidism.
  • Female sex and higher pre-transplant TSH levels are significant predictors of post-allo-SCT hypothyroidism.
  • Pre-transplant TSH measurement can aid in identifying patients at higher risk for developing hypothyroidism.