Volume : 3, Issue : 2, FEB 2017

A STUDY OF CORRELATION BETWEEN THYROID HORMONE PROFILE (SERUM FREE T4 AND TSH) AND SERUM FERRITIN LEVEL IN TRANSFUSION DEPENDENT ?-THALASSEMIC PATIENTS

Dr. Soumitra Ghosh, Dr. Sujit Kumar Dey, Dr Sangita Biswas, Dr. Avishek Sengupta, Dr. Sudipta Banerjee

Abstract

Transfusion related iron overload is the primary therapeutic complication in βthalassemia major patients. Iron deposition in various endocrinal glands is responsible for the hormonal derangements. One of the reported endocrinopathy is hypothyroidism. The present study was aimed to evaluate thyroid hormone profiles and serum ferritn level in transfusuion dependent β thallasemic patients and to find out whether there was any significant correlation between them. Serum ferritin, free T4 and TSH were measured by ELISA method in diagnosed transfusion dependent beta thalassemia patients . Serum ferritin level (1975.11±687.28ng/ml) in patients was higher than normal reference value whereas free T4 level( 0.90± 0.26 ng/dl) was nearer to lower range and TSH level (5.82±2.08) was nearer to higher range of normal reference value. This study demonstrated significant positive correlation between TSH and serum ferritin level (r=0.694) and significant negative correlation between fT4 and Ferritin (r= -0.731) (P value<.001). This study demonstrated that 24 patients (30%) of total thalassemic patients (n=80) had one kind of thyroid dysfunction. Ferritin levels were significantly high in patients with thyroid dysfunction (2667.46±536.24ng/ml) than euthyroid patients (1678.39±509.38ng/ml) (p<0.001). High Serum ferritin level in beta thalassemia patients reflects iron overload in body. High Ferritn level was significantly related to thyroid hormone profile. Deposition of iron in thyroid gland and other tissues may cause oxidative damage affecting thyroid hormones synthesis or its peripheral conversion. Thus high serum ferritin level may indicate the need of thyroid hormone assessment for early detection and initiation of treatment of thyroid disorders in transfusion dependent β-Thalassemia patients.

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References

1. Verma IC. The challenge of genetic disorders in India. In: Molecular genetics and gene therapy- the new frontier, Scientific Communications, Amsterdam 1994; pp11-20. 2. Bashyam MD, Bashyam L, Savithri GR et al. Molecular genetic analyses of beta thalassemia in South India reveal rare mutations in the beta globin gene. Journal of Human Genetics 2004; 49: 408-413.
3. Gupta A, Hattori Y, Gupta UR et al. Molecular genetic testing of beta- thalassemia patients of Indian origin and a novel 8bp deletion mutation at codons 36/37/38/39. Genet Test 2003 7: 163-8. 4. Ferdaus MZ, Hasan AKMM , Shekhar HU Analysis of serum lipid profiles, metal ions and thyroid hormones levels abnormalities in β-thalassaemic children of Bangladesh, J Pak Med Assoc, May 2010 Vol. 60, No. 5 5. Vullo C, De Sanctis V, Katz M, et al. Endocrine abnormalities in thalassaemia. Ann NY Acad Sci 1990; 612: 293-310. 6. Fucharoen S, Ketrichit P, Pootrakul P. Clinical manifestation of beta thalassemia/ hemoglobin E disease. J Pediatr Hematol Oncol. 2000; 22: 552-57. 7. William E.Schreiber.Iron and Porphyrin Metabolism In:Lawrence A.Kaplan,Amadeo J.Pesce (eds) ,Clinical Chemistry,5th edition,2010,Mosby Elsevier, 759-761 8. Michael R .Hemoglobinopathies, in: Richard E, Behrman R , Kliegman R(eds) Nelson textbook of pediatrics, 18th ed. Philadelphia WB saunders , co. 2007 ; 2033-2037. 9. TemizkanAK Kurtoglu AU, Erdal Kurtoglu E, Effect of iron overload on endocrinopathies in patients with beta-thalassaemia major and intermedia Polish Journal of Endocrinology 2012 63(4); 104 10. Zervas A, Katapodi A, Protonotariou A et al. Assessment of thyroid function in two hundred patients with beta-thalassemia major. Thyroid 2002; 12: 151–154 11. Sara Ahmed Malik S.A., Syed S., AhmedN,Frequency of hypothyroidism in patients of β-thalassaemia JPMA; 2010: 60(1) 17 12. Hashemi MD, Ordooei. MD, Golestan.MD Hypothyroidism and Serum Ferritin Level in Patients with Major ß Thalassemia, Iranian Journal of Pediatric Hematology Oncology 2011Vol1.No2. 13. Geeta Gathwala, Kunal Das and Nitika Agrawal Thyroid hormone profile in beta-thalassemia major children Department of Pediatrics, Pt. B.D. Sharma Postgraduate Institute of Medical Science, DOI: 10.3329/bmrcb.v35i2.2534 14. Magro S, Puzzonia P, Consarino C et al. Hypothy- roidism in patients with thalassemia syn- dromes. Acta Haematol 1990; 84: 72-6. 15. Hussein Kadhem, Abdul Hussein Al-Hakeim ,Manal Farhan Mohsen et al. The Effect of Iron Overload on the Function of Some Endocrine Glands in β-Thalassemia Major Patients, Magazin of Al -Kufa University for Biology 2013 :5(2) ISSN: 2073-8854 16. Samra N M; Abdelmoktader A M; Ahmed AK et al. , Assessment of Thyroid Dysfunction in Children with Beta – Thalassemia Major Attending Outpatient Clinic, Fayoum University Hospital, Journal of American Science 2016;12(3)
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17. Esposito BP, Breuer W, Sirankapracha P, et al. Labile plasma iron in iron overload: redox activity and susceptibility to chelation. Blood. 2003 Oct;102 (7):2670-7. 18. Pirinccioglu AG, Deniz T, Gokalp D, Assessment of thyroid function in children aged 1-13 years with Beta- thalassemia major. Iran JPediatr. 2011 Mar; 21(1):77-82. 19. Thuret I, Pondarre C, Loundou A, et al. Complications and treatment of patients with beta-thalassemia in France: results of the National Registry. Haematologica. 2010 May;95(5):724-9. 20. Eschragi P, Tamaddoni A, Zarifi K, et al. Thyroid function in major thalassemia patients: Is it related to height and chelation therapy? Caspian J Intern Med. 2011 Winter;2(1):189-93. 21. Jaruratanasirikul S, Wongcharnchailert M, Laosombat V, etal.: Thyroid function in beta-thalassemic children receiving hypertransfusions with suboptimal iron-chelating therapy. J Med Assoc Thai. 2007 Sep; 90(9):1798-802. 22. Shamshirsaz AA, Bekheirnia MR, Kamgar M, et al. Metabolic and endocrinologic complications in beta-thalassaemia major: a multicenter study in Tehran. BMC Endocr Disord 2003; 3: 4. 23. Zervas A, Katopodi A, Protonotariou A, et al. Assessment of thyroid function in two hundred patients with beta- thalassaemia major. Thyroid 2002; 12: 151-4. 24. Landau H, Matoth I, Landau-Cordova Z, et al.. Cross-sectional and longitudinal study of the pituitary thyroid axis in patients with thalassaemia major. Clin Endocrinol (Oxf) 1993; 38: 55-61. 25. Worwood M, Cragg SJ, Jacobs A, et al.. Binding of serum ferritin to concanavalin A: patients with homozygous beta thalassaemia and transfusional iron overload . Br J Haematol 1980; 46: 409-16 26. De Virgilis S, Sanna G, Cornacchia G, et al.. Serum ferritin, liver iron stores, and liver histology in children with thalassaemia. Arch Dis Child 1980; 55: 43-5.