Early-onset thyrotoxicosis after unrelated cord blood transplantation for acute myelogenous leukemia.
Thyroid dysfunction is a common complication after allogeneic hematopoietic stem cell transplantation (SCT). However, thyrotoxicosis as defined by elevated serum-free thyroxine (FT4) or free triiodothyronine (FT3) levels together with low thyroid-stimulating hormone (TSH) levels is rare after SCT. Here we describe 2 patients who developed thyrotoxicosis within the first 50 days after unrelated cord blood transplantation (CBT). Patient 1 is a 32-year-old woman with acute myelogenous leukemia (AML)-M5a who underwent CBT. On day +41, she developed tachycardia. On day +48, FT4 increased to 2.2 ng/dL and TSH was suppressed to less than 0.1 microU/mL. Antithyroid peroxidase antibody was positive. On day +83, FT4 spontaneously decreased to 1.4 ng/dL. Patient 2 is a 42-year-old man with AML-M4 who underwent CBT. On day +42, he developed tachycardia. On day +48, FT3 increased to 4.75 pg/mL and TSH was suppressed to 0.02 microU/mL. Antithyroid peroxidase antibody was positive. Eight months after CBT, his thyroid function spontaneously returned to normal. The presence of antithyroid peroxidase antibody suggested that immune-mediated reactions might be associated with the development of thyrotoxicosis after CBT in our patients. The present study shows that thyrotoxicosis can occur during very early periods after CBT.
Konuma
Takaaki
T
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Japan.
Tomonari
Akira
A
Takahashi
Satoshi
S
Ooi
Jun
J
Tsukada
Nobuhiro
N
Yamada
Toshiki
T
Sato
Hiroyuki
H
Nagayama
Hitomi
H
Iseki
Tohru
T
Tojo
Arinobu
A
Asano
Shigetaka
S
D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001327:Autoimmune Diseases / Q000097:blood* / Q000209:etiology / Q000276:immunology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications / Q000276:immunology / Q000628:therapy; D008297:Male; D012075:Remission, Spontaneous; D013971:Thyrotoxicosis / Q000097:blood* / Q000209:etiology / Q000276:immunology; D013974:Thyroxine / Q000097:blood / Q000276:immunology; D014184:Transplantation, Homologous; D014284:Triiodothyronine / Q000097:blood / Q000276:immunology
D001323:Autoantibodies; D014284:Triiodothyronine; D007453:Iodide Peroxidase; D013974:Thyroxine