SHORT-TERM AND LONG-TERM FOLLOW-UP OF THYROID-DYSFUNCTION AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION WITHOUT THE USE OF PREPARATIVE TOTAL-BODY IRRADIATION

We studied the incidence and potential prognostic value of thyroid abn ormalities after allogeneic bone marrow transplantation (BMT) without total body irradiation (TBI) conditioning, 77 consecutive patients who received a chemotherapy-alone-based conditioning regimen pretransplan t were included. Free serum thyroxine (FT4), free serum triiodothyroni ne (FT3) and serum thyrotropin (TSH) levels were assayed before and 3 and 14 months after BMT. Patients were classified in three categories: normal thyroid profile if FT3 and FT4 were within the normal range an d TSH was normal or low, peripheral thyroid insufficiency (PTI) if TSH was >4 mIU/I, or an 'euthyroid sick syndrome' (ETS) if FT3 and/or FT4 were low and TSH was normal or low, The incidence of thyroid dysfunct ion at 3 months was 57%, and 29% at 14 months. This was mostly due to the occurrence of ETS which was more frequent at 3 months (48%, 29/61) than at 14 months (19%, 9/48), Furthermore, at 3 months, survival was significantly lower in the ETS group (34.5%) than in the euthyroid gro up (96:2%), or in the PTI group (83.3%) (P < 0.0001). PTI was observed even in the absence of TBI in 11 patients (14%) and was equally distr ibuted at 3 months (n = 6) and 14 months (n = 5), In conclusion, thyro id dysfunction is not a rare complication even without pretransplant T BI conditioning regimen. Hypothyroidism prevalence was 10%, and ETS, w hich was more frequently observed, displayed a dismal predictive value at 3 months.