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Observational Study
. 2023 Sep;46(9):1825-1834.
doi: 10.1007/s40618-023-02039-x. Epub 2023 Mar 8.

Impact of allogeneic stem cell transplantation on thyroid function

F Felicetti  1   2 , F Gatti  3   4 , D Faraci  5 , D Rosso  4 , M Zavattaro  6   7 , N Fortunati  3   4 , L Marinelli  6 , S Leone  8 , J Gill  9   10 , M Dionisi-Vici  3 , C Dellacasa  9 , A Busca  9 , L Giaccone  9   10 , E Arvat  4 , B Bruno  9   10 , E Brignardello  3
Affiliations
Observational Study

Impact of allogeneic stem cell transplantation on thyroid function

F Felicetti et al. J Endocrinol Invest. 2023 Sep.

Abstract

Purpose: Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors.

Methods: One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated.

Results: After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%.

Conclusions: About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.

Keywords: Adults; Allogeneic stem cell transplantation; Cancer survivorship; Hypothyroidism.

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