A case of thyrotoxicosis following peripheral blood stem cell transplantation
Thyroid dysfunction may occur in patients after haematopoietic stem cell transplantation. We report a 41-year-old gentleman who was investigated for bicytopenia in June 2012 after presenting with pruritus and gum bleeding. His initial bone marrow aspiration (BMA) showed features of thrombocytopeni...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
ASEAN Federation of Endocrine Societies
2015
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/50106/ http://irep.iium.edu.my/50106/ http://irep.iium.edu.my/50106/4/50106.pdf |
| Summary: | Thyroid dysfunction may occur in patients after haematopoietic stem cell transplantation. We report a
41-year-old gentleman who was investigated for bicytopenia in June 2012 after presenting with pruritus
and gum bleeding. His initial bone marrow aspiration (BMA) showed features of thrombocytopenia,
which persisted despite treatment with oral steroid. A repeat BMA a year later revealed hypocellular
marrow with full blood pictures showed persistent bicytopenia with presence of blast cells. Acute myeloid
leukaemia was later confirmed with subsequent BMA. First induction/consolidation chemotherapy was
performed in September 2013. He had persistent disease despite reinduction chemotherapy 6 weeks
later. He underwent allogeneic peripheral blood stem cell transplantation (PBSCT) in March 2014.
His donor was his brother who has had no significant medical problems including thyroid disease.
The transplantation was complicated by neutropenic sepsis, which later resolved. Three weeks post
transplantation he was noted to have suppressed thyroid-stimulating hormone levels with elevated free
thyroxine levels and upper limit of free T3 (TSH <0.001 uIU/ml, fT4 24.59 pmol/l, fT3 4.1 pmol/l).
His TSH a month before transplantation was 0.27 uIU/ml. However, his free T4 dan T3 levels were
not available. He was otherwise asymptomatic. His thyroid antibodies later were found to be normal
(anti-thyroglobulin, ATG <20 IU/ml; anti-thyroid peroxidase, anti-TPO 15.8 IU/ml). As he remained
asymptomatic of thyrotoxicosis, he chose not to be treated medically and was given a follow-up in
the clinic. This case illustrates the possible thyroid dysfunction following haematopoietic stem cell
transplantation, which may or may not related to autoimmunity. Autoimmune thyroid disease (AITD) is
a recognised complication of autologous or allogeneic haematopoietic stem cell transplantation (HSCT).
In a series, 10 cases of autoimmune thyroid disease were diagnosed among 721 HSCT recipients, with
three having features of hypothyroidism, five had hyperthyroidism and two had sequential hypo- and
hyperthyroidism. Significant risk factors included HSCT for chronic myeloid leukaemia, HLA B46 and
DR9 loci, the A2B46DR9 haplotype and female donors. Prior to the series, there were 17 reported cases
of AITD after allogeneic HSCT (12 had hyperthyroidism, 5 had hypothyroidism). |
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