Long-term follow-up of thyroid function in patients who received bone marrow transplantation during childhood and adolescence.
An increasing number of long-term surviving bone marrow transplant (BMT) recipients have recovered from their primary disease but are at risk of developing failure of endocrine organs. We investigated 147 patients who underwent allogeneic BMT. Thyroid function was evaluated by serial measurement of basal TSH and free T4 levels as well as by TRH provocative test. Thyroid ultrasound examination was performed for evaluation of thyroid tumor after BMT. Five patients were found to have overt thyroid dysfunction (hypothyroidism in four patients and hyperthyroidism in one patient). Twenty-three patients in the under 9-yr-old group at BMT and 16 patients in the over 10-yr-old group at BMT had subclinical compensated hypothyroidism. Younger age at BMT was the strongest factor for developing thyroid dysfunction, compared with older age (P < 0.001). Only in patients with subclinical compensated hypothyroidism did median basal and peak TSH increase to the upper half of the normal range by 8 yr after BMT and then returned slightly to the middle of the normal range spontaneously. These results suggest that thyroid dysfunction in long-term BMT survivors depends on age at BMT, with a greater risk among younger patients, indicating the need for life-long surveillance.
Ishiguro
Hiroyuki
H
Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan. h-ishi@is.icc.u-tokai.ac.jp
Yasuda
Yukiharu
Y
Tomita
Yuuichiro
Y
Shinagawa
Tsuyoshi
T
Shimizu
Takashi
T
Morimoto
Tsuyoshi
T
Hattori
Kinya
K
Matsumoto
Masae
M
Inoue
Hiroyasu
H
Yabe
Hiromasa
H
Yabe
Miharu
M
Shinohara
Osamu
O
Kato
Shunichi
S
D000236:Adenoma / Q000209:etiology; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology; D007037:Hypothyroidism / Q000209:etiology; D015994:Incidence; D008297:Male; D013959:Thyroid Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013964:Thyroid Neoplasms / Q000209:etiology; D014463:Ultrasonography