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Thyroid function in children after allogeneic bone marrow transplantation

B Borgström1, P Bolme

  • 1Department of Pediatrics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.

Bone Marrow Transplantation
|January 1, 1994
PubMed
Summary
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Pediatric bone marrow transplant (BMT) patients receiving total body irradiation (TBI) frequently develop thyroid dysfunction. Prophylactic levothyroxine (L-T4) may benefit children undergoing TBI-conditioned BMT.

Area of Science:

  • Pediatric endocrinology
  • Hematology and oncology
  • Bone marrow transplantation

Background:

  • Thyroid function is crucial for growth and development in children.
  • Allogeneic bone marrow transplantation (BMT) is a life-saving procedure for various pediatric conditions.
  • Total body irradiation (TBI) is a common conditioning regimen used in BMT, but its long-term effects on endocrine function are a concern.

Purpose of the Study:

  • To investigate the longitudinal impact of allogeneic BMT on thyroid function in pediatric patients.
  • To determine the incidence and patterns of thyroid dysfunction following TBI-conditioned BMT.
  • To evaluate the potential benefit of prophylactic levothyroxine (L-T4) treatment.

Main Methods:

  • Longitudinal study of 35 children undergoing allogeneic BMT, followed for at least 5 years.

Related Experiment Videos

  • Annual assessment of thyroid-stimulating hormone (TSH), T4, T3 levels, and thyrotropin-releasing hormone (TRH) tests.
  • Comparison of thyroid function between patients who received TBI and those who did not.

    • Main Results:

    • Children transplanted without TBI (severe aplastic anemia, n=6) showed no thyroid dysfunction.
    • In leukemia patients (n=27) conditioned with TBI, 89% exhibited thyroid axis disturbances.
    • Specific dysfunctions included high TSH with low T3/T4 (11%), high basal TSH with normal T3/T4 (37%), and exaggerated TSH response to TRH (41%).

    Conclusions:

    • Conditioning with TBI is the primary cause of thyroid dysfunction after pediatric allogeneic BMT.
    • The high prevalence of thyroid axis disturbances suggests that prophylactic L-T4 treatment for a few years post-BMT may be beneficial.
    • Further research is warranted to confirm the efficacy of prophylactic L-T4 in this pediatric population.