Comparison of thyroid function tests between splenectomised and non-splenectomised β-thalassemia major patients
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Abstract
This study was to evaluate and compare thyroid function tests and serum levels of ferritin in splenectomised and non-splenectomised β-thalassemic patients. This study is a case control study that was conducted in the Thalassemia Center in Ibn Al-Atheer Teaching Hospital in Nineveh Province/ Iraq during March-June 2014. Fifty patients of homozygous β-thalassemia major (TM) and twenty five apparently healthy controls were included in this study. The patients were divided into splenectomised and non-splenectomised patients (each 25 patients). Medical history and blood samples were collected from all participants and serum levels of Thyroid stimulating hormone (TSH), Thyroxine (T4), Free thyroxine (FT4), Triiodothyronie (T3), Free triiodothyronine (FT3), and ferritin in addition to body mass index (BMI) were measured.
There were significant decreases in BMI and serum FT4, while there were significant increases in serum TSH and ferritin in β-thalassemia major (in which 10% were diagnosed with hypothyroidism) in comparison with control participants. No significant differences were found between splenectomised and non-splenectomised patients in all parameters measured except a significant positive correlation between serum ferritin and TSH and a significant negative correlation between serum ferritin and T4 that reflects 16% hypothyroidism in splenectomised patients. In addition, significant increases were found in serum TSH and ferritin and a significant decrease in serum FT4 in splenectomised patients when compared with the control. Moreover, a comparison of non-splenectomised patients with control group showed no significant difference in all parameters measured except a significant increase in serum ferritin level. In conclusion, there were certain significant differences in thyroid function tests between β-thalassemia major patients and the controls, whereas there were no significant differences in the means of all studied parameters between splenectomised and non- splenectomised patients except for the positive significant correlation of serum ferritin with TSH level in splenectomised patients which reflect the hypothyroidism in splenectomised TM patients.
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References
1. Angastiniotis, M. and Modell, B. (2006). Global epidemiology of hemoglobin disorders. In: Cohen AR, ed. Cooley’s anemia: Seventh Symposium. New York, NY: New York Academy of Sciences, USA pp 251–69.
2. Telfer, P.T.; Warburton, F.; Christou, S.; Hadjigavriel, M.; Sitarou, M. and Kolnagou, A. (2009). Improved survival in thalassemia major patients on switching from desferrioxamine to combined chelation therapy with desferrioxamine and deferiprone. Haematologica 94(12): 1777-8.
3. Abdulzahra, M.S.; Al-Hakeim, H.K. and Ridha, M.M. ( 2011). Study of the effect of iron overload on the function of endocrine glands in male thalassemia patients. Asian J Transfus Sci. 5: 127–31.
4. Vichinsky, E.P. (2005). Changing patterns of thalassemia worldwide. Ann N Y Acad Sci 1054: 18-24.
5. Galanello, R. and Origa, R.(2010). Beta-thalassemia. Orphanet Journal of Rare Diseases 5:112.
6. De Sanctis, V.; Eleftheriou, A. and Malaventura, C. (2004). Prevalence of endocrine complications and short stature in patients with thalassaemia major: a multicenter study by the Thalassaemia International Federation (TIF). Pediatr Endocrinol Rev. Suppl 2 : 249-55.
7. Al-Salem, A.H. and Nasserulla, Z. (2002). Splenectomy for children with thalassemia. Int Surg 87: 269-73.
8. Graziano, J.H.; Piomelli, S.; Hilgartner, M.; Giardina, P.; Karpatkin, M. and Andrew, M. (1981). Chelation therapy in beta thalassemia major. III. The role of splenectomy in achieving iron balance. J Pediatr 99: 695-9.
9. Pecorari, L.; Savelli, A.; Cuna, C. D.; Fracchia, S. and Pignatti, C. (2008). The role of splenectomy in
thalassemia major. An update. Acta Pediatrica Mediterranea 24: 57-65.
10. Al-Hakeim, H.K. and Al-Hakany, M.F. (2013). The Effect of Iron Overload on the Function of Some Endocrine Glands in β-Thalassemia Major Patients. Magazin of Al-Kufa University for Biology 5(2): 35-6.
11. Rund, D. and Rachmilewitz, E. (2005). Medical progress in b-Thalassemia. N Engl J Med 353: 1135–46.
12. Salih, K.M. and Al-mosawy, W.F. (2013). Evaluation some consequences of thalassemia major in splenectomized and non-splenectomized Iraqi patients. Int J Pharm Pharm Sci, 5 (Suppl 4): 385-8
13. Borgna-Pignatti, C.; Rugolotto, S.; De Stefano, P.; Zhao, H.; Cappellini, M.D. and Del Vecchio, G.C. (2004) Survival and complications in patients with thalassemia major treated with transfusion and desferrioxamine, Haematologica, 89(10): 1187-93.
14. Kattamis, C.; Liakopoulou, T. and Kattamis, A. (1990). Growth and development in children with thalassemia major. Act Paediatr Scand Suppl 1: 111-7.
15. Asadi-Pooya, A.A. and Karamifar, H. (2004). Body mass index in children with beta-thalassemia major. Turk J Haematol. 21(4): 177-80.
16. Morsy, M.M.; Alnajjar, A.A.; Almuzainy, I.S.; Alhawsawi, Z.M.; Alserafi, M.H. and Ahmed, AA. (2008). splenectomized versus non- splenectomized patients with thalassemia major (Ecocardiographic comparision). Saudi Med J. 29(9):1310-4.
17. Tavazzi, D.; Duca, L.; Graziadei, G.; Comino, A.; Fiorelli, G. and Cappellini, M.D. (2001). Membrane-bound iron contributes to oxidative damage of beta-thalassaemia intermedia erythrocytes. Br J Haematol. 112:48–50.
18. Eldor, A. and Rachmilewitz, E.A. (2002). The hypercoagulable state in thalassemia. Blood 99:36–43.
19. Cappellini, M.D.; Motta, I.; Musallam, K.M. and Taher, A.T. (2010). Redefining thalassemia as a hypercoagulable state. AnnN YAcad Sci 1202:231–6.
20. Belhoul, K.M.; Bakir, M.L.; Saned, M.S.; Kadhim, A.M.; Musallam, K.M. and Taher, A.T. (2012). Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major. Ann Hematol 91:1107-14.
21. Gamberini, M.R.; De Sanctis, V. and Gilli, G. (2008). Hypogonadism, diabetes mellitus, hypothyroidism, hypoparathyroidism: incidence and prevalence related to iron overload and chelation therapy in patients with thalassaemia major followed from 1980 to 2007 in the Ferrara Centre. Pediatr Endocrinol Rev 6(Suppl 1):158–69.
22. Jaruratanasirikul, S.; Chareonmuang, R.; Wongcharnchailert, M.; Laosombat, V.; Sangsupavanich, P. and Leetanaporn, K. (2008). Prevalence of impaired glucose metabolism in beta-thalassemic children receiving hypertransfusions with a suboptimal dosage of iron chelating therapy. Eur J Pediatr 167:873–6.
23. Skordis, N.; Michaelidou, M.; Savva, SC.; Ioannou, Y.; Rousounides, A.; Kleanthous, M.; et. al. (2006). The impact of genotype on endocrine complications in thalassaemia major. Eur J Haematol 77:150–6.
24. Brewer, C.J.; Coates, T.D. and Wood, JC. (2009). Spleen R2 and R2* in iron-overloaded patients with 422 sickle cell disease and thalassemia major. J Magn Reson Imaging 29: 357-64.
25. Burtis, C.A. and Ashwood, E.A. (2008). TIETZ Textbook Of Clinical Chemistry. 6th ed. WB Saunders, Philadelphia. pp 766-79.