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Thyroid function in children after allogeneic bone marrow transplantation
1Department of Pediatrics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
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.
- 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.
Abstract:
Thyroid function was investigated in 35 children after allogeneic BMT. The study was longitudinal and all patients were followed for at least 5 years. Once a year TSH, T4, T3 and the TRH test were performed. Patients with severe aplastic anemia (n = 6) were transplanted without total body irradiation (TBI) and they had no detectable alterations in thyroid function. Patients with leukemia (n = 27) were conditioned with 10 Gy TBI in one fraction. The accumulated frequencies of thyroid dysfunction were 3 of 27 (11%) with high TSH and low T3 or T4 levels, and 10 of 27 (37%) with high basal TSH and normal T3 and T4 levels. An additional 11 of 27 (41%) had an exaggerated TSH response in the TRH test and normal basal TSH and T3/T4 levels. Only 3 of 27 (11%) continued to have normal values. Treatment with levo-thyroxine (L-T4) was given to the patients with a high basal TSH level. As 24 of 27 (89%) children had signs of disturbance in the thyroid axis, prophylactic L-T4 treatment for a few years after BMT with TBI may be of value. The main cause of a change in thyroid function after BMT seems to be conditioning with TBI.