Prevalence of hypothyroidism in a large series of adult thalassemic patients

Raffaella Radin; Leila Danesi; Alberto Ambrogio; Elena Cassinerio; Laura Zanaboni; Maria Domenica Cappellini; Marina Baldini; Maurizio Poggi; Chiara Ottaviani; Vincenzo Toscano; Marco Zavattaro; Francesco Cavagnini; Luca Persani; Massimo Scacchi

doi:10.1530/endoabs.37.EP1036

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Endocrine Abstracts (2015) 37 EP1036 | DOI: 10.1530/endoabs.37.EP1036

ECE2015 Eposter Presentations Thyroid (non-cancer) (160 abstracts)

Prevalence of hypothyroidism in a large series of adult thalassemic patients

Raffaella Radin ¹ , Leila Danesi ¹ , Alberto Ambrogio ¹ , Elena Cassinerio ² , Laura Zanaboni ² , Maria Domenica Cappellini ² , Marina Baldini ² , Maurizio Poggi ³ , Chiara Ottaviani ³ , Vincenzo Toscano ⁴ , Marco Zavattaro ⁵ , Francesco Cavagnini ⁶ , Luca Persani ⁷ & Massimo Scacchi ⁸

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¹IRCCS, Istituto Auxologico Italiano, Milan, Italy; ²Cà Granda Foundation Ospedale Maggiore Policlinico, Milan, Italy; ³II Faculty of Medicine, Sapienza University of Rome, Rome, Italy; ⁴Sapienza, University of Rome, Rome, Italy; ⁵Università del Piemonte Orientale ‘A. Avogadro’, Novara, Italy; ⁶Istituto Auxologico Italiano IRCCS, Neuroendocrinology Research Laboratory, Cusano Milanino, Italy; ⁷Department Medical Sciences and Community Health, IRCCS Istituto Auxologico Italiano, University of Milan, Milan, Italy; ⁸Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Hypothyroidism has been traditionally described as a frequent endocrine complication of thalassemic children: in these patients hypothyroidism is mainly of primary origin and not linked to autoimmunity (Mariotti et al., Pediatr Endocrinol Rev 2011). Fewer data are available on the prevalence and nature of this complication in adult age thalassemia. Therefore, we elected to evaluate thyroid function and autoimmunity in a large series of adult patients.

Study: Ninety-five adult thalassemic subjects (48 women and 47 men, mean age 38.1±6.9 years) underwent assessment of thyroid function (fT₃, fT₄ and TSH) and thyroid autoimmunity (anti-thyroid peroxidase and anti-thyroglobulin antibodies). Serum ferritin was also measured in all patients, who were regularly taking iron-chelating drugs. Hormone deficiencies other than hypothyroidism were adequately replaced.

Results: Thirty-one patients (32.6%), 16 men and 15 women, aged 39.5±6.7 years, turned out to be affected by hypothyroidism. Two of them had previously undergone-thyroid surgical removal for multinodular goitre and carcinoma, respectively. The stratification by age of the other hypothyroid subjects disclosed a prevalence of 25% (2/8) among those aged 20–30, 27% (10/37) among those aged 30–40, and 36% (16/44) among those aged 40–50. No hypothyroid patients displayed anti-TPO or anti-TG antibodies. No cases of secondary hypothyroidism were observed. Mean serum ferritin was not significantly different between hypothyroid and euthyroid thalassemic subjects (1067.7±664.5 vs 868.0±743.5 ng/m, NS, respectively).

Comment: Hypothyroidism, primary in all cases, was highly prevalent in our series, being present in one third of the patients. This endocrine complication was equally distributed among genders and its prevalence appeared to progressively increase with age. Since measurement of serum ferritin expresses an estimation of the current degree of iron overload and not its evolution within the clinical history of patients, our data cannot rule out a contribution of secondary hemosiderosis to the pathogenesis of hypothyroidism in thalassemia.