Thyroid Dysfunction in Adult Long-term Survivors After Hemapoeitic Stem-cell Transplantation (HSCT)

Abstract

Thyroid function was evaluated in 72 adult survivors (41 females and 31 males) at 16 to 56 years of age, 1.5 years mean time (range 0.2 - 9.8) after hemapoeitic stem cell transplantation (HSCT) with no known prior history of thyroid dysfunction. Thyroid stimulating hormone (TSH) and free thyroxin levels (FT₄) were determined before and after stimulation with thyrotropin releasing hormone (TRH). Conditioning regimens for HSCT did not include TBI. Overt hypothyroidism (basal TSH > 8 μIU/ml, FT₄ < 0.8 ng/dl) was observed in 6 % of male patients and 5 % of female patients; subclinical hypothyroidism (basal TSH 4 - 8 μIU/ml, low normal FT₄ 0.8 - 1.9 ng/dl) was observed in 13 % of males and 5 % of females. A significant number of euthyroid patients (40 % males and 54 % females) with normal basal TSH and FT₄ levels overresponded to TRH stimulation; the finding being statistically significant (p < 0.005). A heavy TSH response after TRH stimulation indicates compensated subclinical dysfunction of the thyroid gland. Chemotherapy-only conditioning regimens may have an adverse effect on thyroid gland function not always detected by determination of basal TSH and FT₄ levels. This finding warrants long-term evaluation of thyroid function in HSCT patients.

Key words

Thyroid dysfunction - Overt primary hypothyroidism - Subclinical hypothyroidism

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