Thyroid function, autoimmunity and nodules in hematological malignancies

Abstract

Objective: Hematological malignancies encompass a large spectrum of disease entities whose treatment by chemo/radiotherapy could lead to thyroid complications. To the best of our knowledge, no study has simultaneously addressed thyroid function, autoimmunity and nodularity. Therefore, we decided to conduct one. Materials and methods: We evaluated 82 Caucasian patients (36 women and 46 men), who were treated at our Oncology division for hematological malignancies (multiple myeloma, chronic myeloid leukemia, chronic lymphatic leukemia, non-Hodgkin lymphoma and polycythemia vera) and compared them with a control group of 104 patients. Patients who had received or were receiving external head/neck radiotherapy were excluded. All oncological patients and control individuals underwent thyroid ultrasonography and thyroid function and autoimmunity tests. Results: A lower prevalence of enlarged thyroid and nodules were found in patients with respect to controls. The rate of thyroid nodules was the highest in multiple myeloma and polycythemia vera, and the lowest in chronic lymphatic leukemia. Non-Hodgkin lymphoma patients had the smallest thyroid nodules while men with multiple myeloma the biggest ones. No patient had hypothyroidism, while 5.6% of patients had subclinical hyperthyroidism. In contrast, within the control group the rates of hypothyroidism and hyperthyroidism, overt and subclinical, were 3.8%, 20.2%, 0% and 0% respectively. Moreover, the overall rate of thyroid autoantibody positiveness in patients was significantly lower than controls. Conclusion: In our experience, we found a significantly lower prevalence of thyroid abnormalities in hematologic patients who underwent chemotherapy, but not radiotherapy, with respect to controls. Arch Endocrinol Metab. 2015;59(3):236-44

Thyroid Hormone Autoantibodies: Are They a Better Marker to Detect Early Thyroid Damage in Patients with Hematologic Cancers Receiving Tyrosine Kinase Inhibitor or Immunoregulatory Drug Treatments?

“…The rate of thAb positivity was significantly higher than the rates of tpoAb positivity (13% vs. 2%, p = 0.001) and TgAb positivity (13% vs. 0%, p = 0.0006) found in our previous report 5 . Patients with normal tsh levels were also identified as having thAbs (13% vs. 7%, p = 0.05).…”

“…Moreover, thAbs were identified in only 1 person in the control group 5,13 , further underlining the trustworthiness of this marker. …”

“…However, identifying thyroid disease in cancer patients, and especially early damage to the gland, can be difficult 5 . Here, we provide evidence that thAbs are good markers of early thyroid damage in this setting, allowing for treatment modification before hormone dysregulation occurs.…”

“…We previously showed-in a cohort of 82 patients with hematologic malignancies who were treated with either tyrosine kinase inhibitors or immunoregulatory drugs and who were tested for a minimum of 3 years from the beginning of chemotherapy (range: 3-9.9 years; median: 61 months)-that the rates of thyroid autoimmunity [thyroglobulin antibody (TgAb), thyroperoxidase antibody (tpoAb)] and thyroid function [tsh, free T3 and T4 (ft3, ft4)] were low, and that the observed effects were limited mainly to patients with multiple myeloma (mm) and non-Hodgkin lymphoma (nhl) 5 . Nevertheless, from experimental models of thyroiditis, it is known that the first thyroid antibodies (Abs) to appear in circulation are those directed against iodinated hormonogenic epitopes of thyroglobulin-namely, Abs binding thyroid hormones (thAbs) [6][7][8] .…”

AL amyloidosis, hypothyroidism and reduced tissue availability of thyroid hormones by thyroid hormone‐binding immunoglobulin: a new possible perspective

“…In a study on 82 patients with haematologic malignancies (MM, n = 22, non-Hodgkin lymphoma [NHL], n = 36; chronic lymphocytic leukaemia [CLL], n = 4; chronic myeloid leukaemia [CML], n = 8; polycythemia vera [PV], n = 12) and 104 controls matched for demographic characteristics, the following ultrasonographic data were found [6]. Enlarged thyroid (goitre) was detected only in patients with MM (10%) or PV (17%).…”