Thyroid Research Thyroid Research Archive Nonthyroidal Illness
The background of the study. Bone marrow transplantation is an effective therapy for several hematologic diseases, but has many complications. In this study, thyroid and other endocrine function was evaluated in a group of patients who had received bone marrow transplants.
How the study was done. The study subjects were 40 patients (21 women, 19 men) with hematologic disease who received bone marrow cells from their siblings and who were disease-free one or more years later. Twenty-two patients had acute leukemia, 16 chronic leukemia, and 2 aplastic anemia. All received prolonged immunosuppressive drug and glucocorticoid therapy before and for a prolonged period after transplantation to prevent or treat rejection of the transplant or graft-versus-host disease, (GVHD) in which the transplanted cells damage host tissues. The median duration of follow-up was 38 months (range, 12 to 62).
The results of the study. After transplantation, 12 patients (30 percent) had some abnormality in thyroid function. Four patients with chronic GVHD 1 to 4 years after transplantation had low serum free triiodothyronine concentrations and normal serum free thyroxine and thyrotropin (TSH) concentrations, consistent with nonthyroidal illness. Six patients had subclinical hyperthyroidism when first studied after transplantation; the three patients studied again later had normal serum TSH concentrations. Two patients had subclinical hypothyroidism five and six years after transplantation.
With respect to other hormones, most of the women had permanent ovarian deficiency, whereas few men had testicular deficiency. No patient had permanent adrenal insufficiency or growth hormone deficiency, but 11 patients (28 percent) had low serum insulin-like growth factor 1 concentrations.
The conclusions of the study. Endocrine dysfunction is common among patients with hematologic diseases treated with bone marrow transplantation.
The original article. Tauchmanova L, Selleri C, De Rosa G, Pagano L, Orio F, Lombardi G, Rotoli B, Colao A. High prevalence of endocrine dysfunction in long-term survivors afte