Endocrine Abstracts

Introduction: Endocrinopathies are a common late effect of haematopietic stem cell transplantation, resulting in thyroid dysfunction, impaired growth and pubertal development during childhood and metabolic syndrome. Because of the possible endocrine complications, transplanted patients need life-long endocrine follow-up.

Case report: A 14-year-old male patient with a history of Fanconi anemia (7 years), bone marrow transplant (10 years) and Graves Disease (13 years) was admitted in our endocrine department for evaluation in November 2015. He was diagnosed six month ago with hyperthyroidism (TSH<0.004 uIU/ml, FT4=4.44 ng/ml, ATPO=324 IU/ml, TRAb=28 U/l) and started treatment with metimazole (MMI). On antithyroid drugs his symptomatology improved, with normalization of FT4 and TT3 (TSH remained suppressed), but when we tried to decrease the dose of MMI, FT4 and TT3 became elevated again and the dose of metimazole was increased again at 20 mg/day. At present admission the physical exam revealed goiter, H=151.6 cm (−1.25 S.D.), W=49 kg, BMI=21.32 kg/m², upper eyelids swelling, retraction of the lower eyelids, discrete eyelids erythema, mild exophtalmia, especially at his left eye-signs that were not present in September, at his last visit in our hospital. The ophtalmological consultation diagnosed evolutive orbitopathy and suggested considering glucorticoid therapy. The level of TSH receptor antibodies decreased during antithyroid treatment, but they were still elevated (14.2). He started a 6-month course of selenium supplementation (100 μg/day) and pulsetherapy with methyprednisolone 125 mg/week for 3 weeks and 250 mg/week for the next 3 weeks with a good clinical outcome.

Conclusion: Graves’ orbitopathy is a rare complication in transplanted patients and was not present in our patient from the start. In this situation, euthyroidism is essential for improvement of eye changes, but sometimes other therapeutic interventions are needed.