Low T3-syndrome and nutritional status as prognostic factors in patients undergoing bone marrow transplantation

Abstract

Summary:Bone marrow transplantation is known to be associated with considerable morbidity and mortality. The aim of this study was to determine the influence of nutritional status and development of sick euthyroid syndrome as prognostic factors for outcome after BMT. In 100 patients who underwent transplantation the following parameters were assessed before and at day 14 and 28 after transplantation: anthropometric data (body weight, body mass index, body composition, grip strength), rapid turnover proteins transferrin and prealbumin, T4, T3, free T4, reverse T3, thyroid-stimulating hormone and thyroglobulin. Following bone marrow transplantation, 22 patients died in the short-term follow-up (group A) before day 140 after BMT, 21 patients died during further follow-up between days 140 and 365 (group B) and 57 patients survived longer than 365 days (group C). All patients experienced a significant decrease of transferrin and T3, accompanied by an increase of rT3 and rT3/T3 ratio at day 14 after BMT. At day 28 after BMT, patients in group C showed recovery from these changes with an increase of transferrin and a fall in rT3 and the rT3/T3-ratio, which was not seen in patients who died during further follow-up (groups A and B). The observed changes were independent of other prognostically relevant factors (type of disease, HLA-match, immunosuppression). Impaired nutritional status and development of a sick euthyroid syndrome, without tendency to recovery, are associated with a higher probability of fatal outcome after bone marrow transplantation and have prognostic relevance in this group of patients.

Body weight recovery, eating difficulties and compliance with dietary advice in the first year after stem cell transplantation: a prospective study

“…The prevalence in our patient group was higher, probably due to the fact that our measurements were more frequent (five times) and our first measurement (day 50) was earlier in the recovery phase. The fact that only a minority of patients appears to regain their pre-morbid nutritional status at day 350 is also reported by Schulte et al 13 They found in a group of 100 stem cell transplant recipients with haematological malignancies that the survivors after 1 year did not regain their pre-transplant physical condition, showed lower body weights, decreased muscle mass and grip strength as compared to baseline. We did not find any study that shed light on the dietary intake and compliance with dietary advice in the first year post transplant.…”

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

“…After 4 weeks post HSCT the thyroid hormone parameters had normalized in patients who had an uneventful course. 36 In line with previous studies, we found normal serum levels of T 3 , T 4 and TSH, 1 to 12 months after HSCT. Thyroid function in long-term survivors after HSCT has been studied by several groups.…”

“…However, the levels of thyroid hormone expression after HSCT have been extensively explored, and short-term changes in thyroid metabolism were investigated by Schulte et al 36 The initial decrease in TSH and T 3 within 2 weeks post HSCT was interpreted as an effect of the HSCT per se. After 4 weeks post HSCT the thyroid hormone parameters had normalized in patients who had an uneventful course.…”

Thyroid hormone in health and disease

“…This association undoubtedly reflects the influence of 'non-thyroidal' illnesses of increasing severity on thyroid hormone metabolism and TSH secretion. For example, low serum T3 has been reported to be an independent predictor of poor survival among critically ill patients (Maldonado et al 1992) and low serum T4 and T3 are associated with poor outcome in subjects undergoing bone marrow transplantation (Vexiau et al 1993, Schulte et al 1998. Furthermore, in elderly subjects, reduced circulating thyroid hormones are associated with worse nutritional state and worse post-operative outcome in those undergoing emergency surgery (Girvent et al 1998).…”