title: Short- and long-term follow-up of thyroid dysfunction after allogeneic bone marrow transplantation without the use of preparative total body irradiation.
abstract: We studied the incidence and potential prognostic value of thyroid abnormalities after allogeneic bone marrow transplantation (BMT) without total body irradiation (TBI) conditioning. 77 consecutive patients who received a chemotherapy-alone-based conditioning regimen pretransplant were included. Free serum thyroxine (FT4), free serum triiodothyronine (FT3) and serum thyrotropin (TSH) levels were assayed before and 3 and 14 months after BMT. Patients were classified in three categories: normal thyroid profile if FT3 and FT4 were within the normal range and TSH was normal or low, peripheral thyroid insufficiency (PTI) if TSH was >4 mIU/l, or an 'euthyroid sick syndrome' (ETS) if FT3 and/or FT4 were low and TSH was normal or low. The incidence of thyroid dysfunction at 3 months was 57%, and 29% at 14 months. This was mostly due to the occurrence of ETS which was more frequent at 3 months (48%, 29/61) than at 14 months (19%, 9/48). Furthermore, at 3 months, survival was significantly lower in the ETS group (34.5%) than in the euthyroid group (96.2%), or in the PTI group (83.3%) (P < 0.0001). PTI was observed even in the absence of TBI in 11 patients (14%) and was equally distributed at 3 months (n = 6) and 14 months (n = 5). In conclusion, thyroid dysfunction is not a rare complication even without pretransplant TBI conditioning regimen. Hypothyroidism prevalence was 10%, and ETS, which was more frequently observed, displayed a dismal predictive value at 3 months.
authors.affiliation: Nuclear Medicine Department, Hôpital Saint-Louis, Paris, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Toubert
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: S
authors.initials: S
authors.lastname: Aractingi
authors.forename: H
authors.initials: H
authors.lastname: Espérou
authors.forename: A
authors.initials: A
authors.lastname: Devergie
authors.forename: P
authors.initials: P
authors.lastname: Ribaud
authors.forename: N
authors.initials: N
authors.lastname: Parquet
authors.forename: M H
authors.initials: MH
authors.lastname: Schlageter
authors.forename: J P
authors.initials: JP
authors.lastname: Beressi
authors.forename: J D
authors.initials: JD
authors.lastname: Rain
authors.forename: P
authors.initials: P
authors.lastname: Vexiau
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D013959:Thyroid Diseases / Q000209:etiology*; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation