Hypothyroidism and Hypoparathyroidism in Thalassemia Major Patients: A Study in Sistan and Baluchestan Province, Iran

Bazi, Ali; Harati, Hadi; Khosravi-Bonjar, Ali; Rakhshani, Elham; Delaramnasab, Mojtaba

doi:10.5812/ijem.13228

Cited by 18 publications

(14 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This endocrine disorder has also been identified as a main cause of hypocalcemia. Interestingly, previous reports indicated reduced PTH levels in patients with thalassemia major and suggested that these patients would benefit from vitamin D and calcium supplementation [3, 19–21, 32, 33]. Taken together, the findings from our and previous studies suggest that early and effective treatment should be administered to improve bone health.…”

Section: Discussionsupporting

confidence: 71%

“…In these patients, the upregulated absorption of iron leads to a significant reduction in the absorption of calcium [14–18]. Still, many factors other than vitamin D deficiency can cause hypocalcemia in patients with thalassemia; these include hypoparathyroidism, decreased vitamin D and calcium intakes, impaired vitamin D or calcium absorption, and iron overload [19–21]. However, vitamin D deficiency itself remains the leading cause of bone diseases in β-TM patients and may be exacerbated by reduced participation in outdoor activities due to anemia and skeletal malfunction [12, 22].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the vitamin D and biomedical statuses of young children with β-thalassemia major at a single center in southern China

Chen

Wang

et al. 2019

BMC Pediatr

View full text Add to dashboard Cite

BackgroundIn young children, β-thalassemia major (β-TM) is associated with potentially severe clinical characteristics, including poor growth, feeding difficulties, hepatosplenomegaly, bone metabolic disorders, and skeletal abnormalities.MethodsIn this study, we reviewed the demographic and clinical characteristics (e.g., age, sex, duration of blood transfusion and chelating therapy, and vitamin supplementation) and serum biomarker levels (e.g., iron accumulation, bone metabolism, liver, kidney, and thyroid function markers) of 32 patients that received regular blood transfusion at a single center in southern China with the aim of stratifying the risk of severe complications such as osteopenia, endocrinopathies, and multi-organ failures.ResultsAlthough all patients exhibited moderately to strongly elevated serum ferritin levels, this biomarker was significantly higher in children older than ≥5 years, compared to younger children (*p < 0.05, 1512 ± 192.6 vs. 2337 ± 299.8 ng/ml, Mann-Whitney U test). Older children had a significantly lower 25-hydroxy vitamin D3 (25(OH)D3) level, compared to younger children (**p < 0.01, 34.25 ± 11.06 vs. 23.05 ± 9.95 ng/ml, Mann-Whitney U test). No age-related differences were observed in serum calcium, phosphorus, and PTH levels. Regarding liver function, the serum alanine aminotransferase (ALT) level was significantly increased in children older than ≥5 years, compared to younger children (*p < 0.05, 19.17 ± 2.44 vs. 43.45 ± 9.82I U/ml, Mann-Whitney U test). However, no age-related differences were observed in the serum levels of other liver or kidney and thyroid biomarkers.ConclusionsOur results suggest that in older children, hepatic iron overload may be associated with a low serum concentration of 25(OH)D3, an indicator of vitamin D deficiency and altered bone metabolism. Iron accumulation may also be associated with a higher concentration of ALT, a sensitive marker of liver malfunction. These findings may provide important clinical indications of the need for intervention to prevent severe complications in children with β thalassemia.

show abstract

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Evaluation of the vitamin D and biomedical statuses of young children with β-thalassemia major at a single center in southern China

Chen

Wang

et al. 2019

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…Manifestations of hypoparathyroidism include tetany, seizures, carpopedal spasms, and paresthesia, which may or may not be accompanied by hypocalcemia [3]. It is recommended to screen for parathyroid dysfunction periodically, when other iron overload associated complications occur, as ferritin levels do not provide a reliable index of parathyroid function [4].…”

Section: Introductionmentioning

confidence: 99%

Unique classification of parathyroid dysfunction in patients with transfusion dependent thalassemia major using Nomogram-A cross sectional study

Majid

Jafri

Ahmed

et al. 2019

Annals of Medicine and Surgery

View full text Add to dashboard Cite

Introduction Hypoparathyroidism is a rare complication of iron overload in patients with transfusion dependent β thalassemia major (β-TM). We aim to determine the prevalence of parathyroid dysfunction in patients with β-TM. Methods Diagnosed cases of transfusion dependent β-TM between 5 and 17 years of age were recruited from outpatient clinics of a non-profit organization in Karachi, Pakistan. Blood and urine samples were collected in fasting to determine Ca, P, Alb, Mg, Cr 25OHD and iPTH. Patients were grouped on the basis of upper and lower levels of Ca, 25OHD and iPTH for assessing parathyroid dysfunction into primary hypoparathyroidism [ low calcium (Ca) & intact parathyroid hormone (iPTH) ], sub-clinical hypoparathyroidism [ low iPTH and 25 hydroxy vitamin D (25OHD), low/normal Ca], normal functioning parathyroid gland [ Normal Ca, iPTH and 25OHD ] and secondary hyperparathyroidism [ high iPTH, low/normal Ca and/or 25OHD ]. Using PTH nomogram subject specific expected PTH (maxPTH) was calculated. Difference between maxPTH and measured iPTH was determined to assess the utility of nomogram in identifying parathyroid gland dysfunction. The statistical analysis was performed using the Statistical Package of Social Sciences (SPSS) version 20. Results Median age of patients was 11 years (13–7) with males being 54.2% (n = 205). Based on Ca, 25OHD and iPTH, primary hypoparathyroidism was identified in 3.4% (n = 13) [median iPTH 11.3 pg/ml (12.6–7)], 52.3% (n = 192) had subclinical hypoparathyroidism [iPTH 40.4 pg/ml (52.7–28.7)], and 34% (n = 125) were identified as secondary hyperparathyroidism [iPTH 88.6 pg/ml (116–74.7)]. Normal response to Ca & 25OHD was seen in 10.6% (n = 39) [iPTH 44.2 pg/ml (53.8–33.4)] patients. High phosphorous was present in all groups. Difference between maxPTH & iPTH was highest in primary hypoparathyroidism, followed by subclinical and secondary hyperparathyroidism. Conclusion Nomogram by Harvey et al. identify low secretion capacity of parathyroid gland that correlated with biochemical classification of patients. It requires clinical validation before using in clinical practice for assessing parathyroid dysfunction.

show abstract

“… 14 Although more known for its role in overwhelming infectious complications, splenectomies were also investigated as a separate risk factor for the development of endocrinopathies in patients with thalassemia. 16 , 17 In this study, a positive history of a splenectomy was considered as a statistically significant risk factor for the development of hypogonadism p =0.026 and hypocortisolism at p =0.026. This might be explained by the role splenectomies play in rapidly precipitating an increase in circulating ferritin levels and favoring the deposition of iron in multiple organs through decreasing the body’s total iron binding capacity.…”

Section: Discussionmentioning

confidence: 99%

Endocrinopathies complicating transfusion-dependent hemoglobinopathy

Al-Agha

Bawahab

Nagadi

et al. 2020

SMJ

View full text Add to dashboard Cite

Objectives: To investigate the prevalence and significance of different endocrinopathies in children and adolescents with transfusion-dependent thalassemia and sickle-cell anemia. Methods: This is a descriptive, retrospective study between January 2010 and July 2018 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data was collected through reviewing electronic hospital medical records then filling out data collection sheets and was interpreted through the IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). Original Article Results: The total sample size was 119 patients, gender equality was almost achieved with 55.5% being male and 45.5% being female. The most common endocrinopathies were identified in the following order of short stature (39.5%), diabetes mellitus (29.4%), hypogonadism (12.6%), osteopenia (12.6%), osteoporosis (9.2%), hypothyroidism (9.2%), hypocortisolism (3.4%), and hypoparathyroidism (2.5%). All of which were statistically significant in their relationship to hemoglobinopathies with the exception of osteopenia and osteoporosis. Hypogonadism and hypocortisolism were found to be statistically significant in their relationship to a positive history of splenectomy at p=0.026 and p=0.012. Short stature was found to be statistically significant in its relationship to the male gender with a p=0.001. Conclusion: Endocrinopathy is a frequent complication of hemoglobinopathies, for which the most common were found to be short stature, diabetes mellitus, and low bone mineral density.

show abstract

Hypothyroidism and Hypoparathyroidism in Thalassemia Major Patients: A Study in Sistan and Baluchestan Province, Iran

Cited by 18 publications

References 15 publications

Evaluation of the vitamin D and biomedical statuses of young children with β-thalassemia major at a single center in southern China

Evaluation of the vitamin D and biomedical statuses of young children with β-thalassemia major at a single center in southern China

Unique classification of parathyroid dysfunction in patients with transfusion dependent thalassemia major using Nomogram-A cross sectional study

Endocrinopathies complicating transfusion-dependent hemoglobinopathy

Contact Info

Product

Resources

About