Changes in thyroid function after bone marrow transplant in young patients.
BACKGROUND
Changes in thyroid function among young patients who received bone marrow transplantation (BMT) were evaluated.


METHODS
The study included 91 patients (50 males) who underwent BMT from 1985 to 1995 at the age of 0.6-21 years. Sixty patients had neoplastic disease such as leukemia or lymphoma, and the remainder had non-neoplastic diseases. Preconditioning regimen for BMT included 12 Gy of fractionated-total body irradiation (TBI) for patients with neoplastic disease and 3-8 Gy of irradiation for the remaining patients, in addition to chemotherapy. Evaluation of thyroid function was performed by serial assessment of basal serum FT4, FT3, TSH concentrations as well as by TRH test.


RESULTS
No patient had overt hypothyroidism or elevated basal TSH concentrations (>10 mU/L). However, 6 (7%) of patients experienced exaggerated peak TSH response to TRH stimulation several years after BMT. In 33 patients whose thyroid status was evaluated before, within 3 months, and 1 year after BMT, serum FT3 concentrations as well as peak TSH response to TRH stimulation significantly decreased immediately after BMT (<3 months) and normalized within 1 year. However, serum FT4 concentrations did not change significantly. One patient developed primary hypothyroidism and another developed follicular adenoma of the thyroid 5 and 12 years after BMT, respectively.


CONCLUSIONS
Short-term changes in thyroid function after BMT can indicate euthyroid sick syndrome rather than tertiary hypothyroidism. It must be noted that overt hypothyroidism may occur several years after BMT, hence long-term follow-up of thyroid function is warranted.
Matsumoto
Masae
M
Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan.
Ishiguro
Hiroyuki
H
Tomita
Yuichirou
Y
Inoue
Hiroyasu
H
Yasuda
Yukiharu
Y
Shimizu
Takashi
T
Shinagawa
Tsuyoshi
T
Hattori
Kinya
K
Yabe
Hiromasa
H
Kubota
Chidori
C
Yabe
Miharu
M
Kato
Shunichi
S
Shinohara
Osamu
O
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005067:Euthyroid Sick Syndromes / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D008297:Male; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology*; D013963:Thyroid Hormones / Q000097:blood; D013973:Thyrotropin-Releasing Hormone; D013997:Time Factors; D019172:Transplantation Conditioning
D013963:Thyroid Hormones; D013973:Thyrotropin-Releasing Hormone