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Changes in thyroid function parameters 3 months after allogeneic and autologous hematopoietic stem cell
Chantal A Lebbink1,2, Dorine Bresters3, Joni P B Tersteeg1
1Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Thyroid dysfunction is rare three months after pediatric hematopoietic stem cell transplantation (HSCT). Most thyroid function changes observed may indicate euthyroid sick syndrome, not overt hypo- or hyperthyroidism.
Area of Science:
- Pediatric Hematology
- Endocrinology
- Transplantation Medicine
Background:
- Thyroid dysfunction (hypo- and hyperthyroidism) is a known late effect of hematopoietic stem cell transplantation (HSCT) in children.
- Short-term impacts of HSCT on thyroid function parameters remain largely uncharacterized.
Purpose of the Study:
- To prospectively assess thyroid function parameters in children undergoing HSCT.
- To clarify the short-term effects of HSCT on thyroid function in pediatric patients.
Main Methods:
- Prospective evaluation of thyroid function tests before and 3 months post-HSCT.
- Study included all children (<21 years) undergoing HSCT over a 2-year period.
- Analysis of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and reverse triiodothyronine (rT3) levels.
Main Results:
- No cases of overt hypothyroidism or hyperthyroidism were observed 3 months post-HSCT in 72 children.
- Aberrant TSH or FT4 levels decreased from 16% pre-HSCT to 10% post-HSCT.
- Elevated rT3 levels increased significantly from 9.3% pre-HSCT to 37% post-HSCT, potentially linked to physical condition.
- A significant decline (≥20%) in FT4 was noted in 10.5% of patients.
Conclusions:
- Overt thyroid dysfunction (hypo- and hyperthyroidism) is uncommon 3 months after pediatric HSCT.
- Surveillance for thyroid dysfunction may be initiated later post-transplant.
- Observed thyroid function changes likely represent euthyroid sick syndrome rather than primary thyroid disease.
Background:
Thyroid dysfunction (hypo- and hyperthyroidism) has been reported as a late effect after hematopoietic stem cell transplantation (HSCT) in children. Short-term effects of HSCT on thyroid function parameters are, however, unclear.
Methods:
We prospectively evaluated thyroid function parameters before and 3 months after HSCT in all children (<21 years) who underwent HSCT during a 2-year period in the Princess Máxima Center, the Netherlands.
Results:
Among 72 children, none had thyroidal hypothyroidism or hyperthyroidism 3 months after HSCT. Changes in thyroid function parameters (either aberrant thyroid-stimulating hormone [TSH] or free thyroxine [FT4] concentrations) were found in 16% before and in 10% 3 months after HSCT. Reverse triiodothyronine (rT3) was found elevated in 9.3% before and in 37% 3 months after HSCT, which could be related to poor physical condition. An individual decline in FT4 concentration of ≥20% was found in 10.5% (6/57) 3 months after HSCT.
Conclusion:
In conclusion, thyroidal hypo- and hyperthyroidism are very rare 3 months after HSCT. These results indicate that surveillance for hypo- and hyperthyroidism may start later in time. The changes in thyroid function parameters found 3 months after HSCT might reflect euthyroid sick syndrome.
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