Relation of elevated serum ferritin levels to hypothyroidism in children with beta-thalassemia major
Background: The commonest form of thyroid dysfunction, seen in thalassaemics, is subclinical hypothyroidism due to abnormalities of the thyroid gland which, leads to insufficient production of thyroid hormones. However, the frequency of hypothyroidism varies depending on the region, quality of management and treatment protocols.
Aim: This study was conducted with the aim of investigating the frequency of hypothyroidism in children with beta-thalassemia major and to study its correlation with serum ferritin.
Material and methods: A case-control study was carried out in the OPD, Medical College, Kolkata. It included 100 children with Beta–Thalassemia major as cases. Hundred age and gender matched healthy controls were also included in the study.
Results: The weight and height of the cases lagged behind those of the control group. Compared to the control group, the mean level of thyroid hormones (both T3 and T4) and Hemoglobin levels were significantly reduced while those of TSH and Serum Ferritin were significantly increased. Out of 100 cases, 64 were euthyroid, 34 and 2% had subclinical and clinical hypothyroidism respectively. No case of secondary hypothyroidism was detected. Our results showed no association between Serum ferritin levels and the frequency of hypothyroidism among studied patients.
Conclusion: Thyroid dysfunction in thalassemia may start early in life, hypothyroidism is not clinically observed in most thalassemia major patients. Therefore, thyroid function should be followed on regular basis when other iron over load associated complications occurs. Regular follow-up for early detection and timely treatment of such complications could improve the quality of life of these patients.
Satwani H, Raza J, Alam M, Kidwai A. Endocrine Complications in Thalassaemias: Frequency and Association with Serum Ferritin Levels. Pak Paediat Assoc J 2005; 29: 113-9.
Lokeshwar MR. Late Hony. Surg. Cmde. Dr. Shantilal C. Sheth oration presentation during PEDICON 2006, Delhi, January 6th, 2006. Progress in the management of thalassemia. Indian Pediatr. 2006 Jun;43(6):503-6.
Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, Hashemi R, Shamshirsaz AA, Aghakhani S, Homayoun H, Larijani B. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord. 2003 Aug 12;3(1):4.doi:https://doi.org/10.1186/1472-6823-3-4.
Abdelrazik N, Ghanem H. Failure of puberty in Egyptian beta thalassemic patients: Experience in north east region - Dakahlia province. Hematology. 2007 Oct;12(5):449–56.doi: https://doi.org/10.1080/10245330701448503.
Al-Rimawi HS, Jallad MF, Amarin ZO, Al Sakaan R. Pubertal evaluation of adolescent boys with beta-thalassemia major and delayed puberty. Fertil Steril.2006; 86:886–90.
Najafipour F, Aliasgarzadeh A, Aghamohamadzadeh N, et al. A cross-sectional study of metabolic and endocrine complications in beta-thalassemia major. Ann Saudi Med. 2008; 28:361–6.doi: https://doi.org/10.5144/0256-4947.2008.361.
GulatiR, BhatiaV, AgarwalSS. Early onset of endocrine abnormalities in beta-thalassemia major in a developing country. J Pediatr Endocrinol Metab 2000; 13 (6):651-6.doi: https://doi.org/10.1515/jpem.2000.13.6.651.
Dodeigne C,Thunus L,Lejeune R.Chemiluminescence as diagnostic tool. A review,Talanta 2000;51(3):415-39.doi: https://doi.org/10.1016/s0039-9140(99)00294-5.
Malik SA, Syed S, Ahmed N.: Frequency of hypothyroidism in patients of beta-thalassemia. Pak I Med Assoc. 2010; 60(1): 17– 29.
Grundy R, Woods K, Savage M, et al.. Relationship of endocrinopathy to iron chelation status in young patients with thalassemia major. Arch Dis Child 1994; 71:128-32.
Gathwala G, Das K, Agrawal N. Thyroid hormone profile in Beta thalassemia major children .Indian J Pediatr 2009; 4(2):20-9.
Moaddab M, Hashemipour,M, Naderi M. The prevalence of endocrine complications in patients with thalassemia major. Eur Cong Endocrinol 2008; 16:578-586.
Sharma S and Aggarwal R. Evaluation of thyroid hormones in Beta-thalassemic children of north India. UJMDS 2014; 2 (1):39-42.
Jain M, Sinha RS, Chellani H, Anand NK. Assessment of thyroid functions and its role in body growth in thalassemia major. Indian Pediatr. 1995 Feb;32(2):213-9.
Costin G, Kogut MD, Hyman CB, Ortega JA. Endocrine abnormalities in thalassemia major. Am J Dis Child. 1979; 133(5):497-502.doi: https://doi.org/10.1001/archpedi.1979.02130050041009.
Magro S, Puzzonia P, Consarino C et al. Hypothyroidism in patients with thalassemia syndromes. Acta Haematol. 1990; 84(2):72-6.doi: https://doi.org/10.1159/000205032.
Khider NA, Hussein FM. Assessment of thyroid function among transfusion dependant thalassemics in Erbil. Middle East journal of family medicine Jan2014; 12(1):5-13.