Abnormal thyroid stimulating hormone (TSH) levels in adults following allogeneic bone marrow transplants

Abstract

Summary:Patient population and methodsThe charts of 350 consecutive patients between the ages of Thyroid function abnormalities in 270 adult patients post-BMT are described. Various conditioning regimens 16 and 57 years transplanted at this Institute from June 1970 to May 1994 and who survived at least 1 year from were used and the effects of three TBI and one chemotherapy only based regimens are compared. The overall transplant were reviewed. Reports of thyroid-related clinical abnormalities confirmed on laboratory testing as well incidence of elevated TSH is 8.9; 3.8, 7.2 and 16.7% in those patients who received 300, 500 and 1200 cGy as routine TSH, T3 and T4 levels were collected. Eighty patients from this cohort were excluded for lack of recorded respectively and 11.7% in those who received BuCy conditioning. Three cases (1.1%) of clinial hypothyroidism TSH levels. Males and females were approximately equally represented, respectively 136 vs 134 patients in the 270 were observed. Compensated hypothyroidism defined as an elevated TSH in the presence of normal T3, T4 levels available patients. The hematological diagnoses included, CML 98 patients; AML 93; ALL 27; AA 23; MDS 9; nonand transient in some cases, was the most common finding. All but four cases occurred in the first 2 years after Hodgkin's lymphoma (NHL) 8; others 12. Two hundred and ten patients received total body irradiation (TBI) from BMT. In the remaining four, three occurred in patients with chronic GVHD. The results reported here show a a 60 Co source at 50-90 cGy/min as a component of the conditioning regimen (Table 1) The remainder received cyclolower prevalence than observed in most other reviews, particularly for children. A trend was observed with phosphamide and busulfan. increasing radiation doses. The results are not significantly different from those we observed in the BuCy regimen.Results Keywords: allogeneic; BMT; thyroid Twenty-four of the 270 patients (10 males, 14 females) were found to have elevated TSH levels ( Table 2). The conditioning regimens in these patients included single fraction With the increase in the number of allogeneic bone marrow TBI in 12 (one received 300 cGy), fractionated TBI in five transplants performed over the last two decades, and the and no TBI in seven. This represents 3.8% of the patients concomitant decrease in early mortality due to infection, in the cohort treated with a single 300 cGy fraction, 7.2% graft failure and GVHD, long-term sequelae of transplanof those treated with a single 500 cGy fraction, 16.7% of tation have become more evident. 1-3 Endocrine abnormalithose treated with 1200 cGy in six fractions and 11.7% of ties, notably hypopituitarism, hypogonadism and hypothythose treated with no radiation in the conditioning regimen. roidism have been reported, primarily in transplanted This trend did not reach statistical significance. Significant children. 4,5 The frequency of hypothyroidism was found to acute GVHD (grade II-IV) developed in 18 of these be as high as 40%, 6-8 and appeared t...

Changes in autoimmune thyroid disease following allogeneic bone marrow transplantation

“…Radiation to the head and neck is a well-known cause of hypothyroidism and more profound hypothyroidism develops with increasing radiation doses. 5 However, hypothyroidism can occur without total body irradiation (TBI), and the patient in case 3 who developed autoimmune thyroiditis following BMT had not received TBI. Thus, other etiologies for post-BMT hypothyroidism may play a role.…”

Thyroid dysfunction after bone marrow transplantation for primary immunodeficiency without the use of total body irradiation in conditioning

“…Hypothyroidism, often compensated and transient, is most common and usually presents at 6-12 months post-BMT, while frank clinical hypothyroidism is rare. 7 Euthyroid sick syndrome 8 and transient thyrotoxicosis 9 may also occur within the first 6 months post-BMT and progress to hypothyroidism later. The mechanisms of hypothyroidism developing post-BMT remain unclear.…”

Altered expression of receptors for thyroid hormone and insulin-like growth factor-1 during reconstitution after allogeneic hematopoietic stem cell transplantation

“…Two recent studies report a low incidence of hypothyroidism after HSCT in patients studied 1-10 years post HSCT. 37,38 In rats, where high levels of T 3 downregulate TR␣1, measured as mRNA or as receptor density, the ligand-receptor interaction of thyroid hormone receptors was demonstrated. 39 Downregulation of TR␣1 mRNA by T 3 has also been demonstrated in cultured cardiomyocytes.…”