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Long-Term Follow-Up of Thyroid Function in Patients Who Received Bone Marrow Transplantation during Childhood and Adolescence

Departments of Pediatrics (H.Is., Y.Y., Y.T., T.Shin., T.Shim., T.M., K.H., M.M., H.In., H.Y., M.Y., O.S., S.K.) and Cell Transplantation and Regenerative Medicine (S.K.), Tokai University School of Medicine, Kanagawa 259-1193, Japan; and Department of Pediatrics (T.Shim.), University of Tsukuba, Tsukuba 305-8577, Japan

Address all correspondence and requests for reprints to: Hiroyuki Ishiguro, M.D., Department of Pediatrics, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan. E-mail: h-ishi{at}is.icc.u-tokai.ac.jp.

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.

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