ESPE Abstracts (2016) 86 P-P1-911

Hyperthyroidism after Bone Marrow Transplantation: A Report of Two Cases

Hiroyuki Ishiguroa,b, Hiromi Hyodoc,b & Shunichi Katod

aDepartment of Pediatrics, Isehara Kyodo Hospital, Isehara, Kanagawa, Japan; bDepartment of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan; cDepartment of Pediatrics, Japanese Red Cross Hadano Hospital, Hadano, Kanagawa, Japan; dDepartment of Cell Transplantation & Regenerative Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan

Background: The thyroid dysfunction is one of the frequently seen complications after bone marrow transplantation (BMT). Although hypothyroidism is the most common thyroid disease after BMT, hyperthyroidism is a rare condition. Herein, we report a series of 2 patients who were euthyroid before BMT but developed hyperthyroidism after transplantation.

Objective: Case reports and the frequency of hyperthyroidism after BMT in our institute. Case 1: A 10-year-old boy was diagnosed with adrenoleukodystrophy and underwent transplantation twice from his HLA-unmatched sister when 10 years of age. Conditioning regimens consisted of thoracoabdominal irradiation + Busulfan (Bu) + Cyclophosphamide (CY) + Antithymocyte globulin (ATG) for the first BMT and Bu + CY + ATG for the second BMT due to a rejection of the first BMT. At the time of both BMTs, his thyroid function tests were normal, respectively, and his donor had no history of thyroid disease. Prophylaxis against graft-versus-host disease (GVHD) was used short-term methotrexate (sMTX) and cyclosporine (CyA). He had acute GVHD presenting with nodular rash and prednisolone was initiated. Although subclinical compensated hypothyroidism was demonstrated after the first BMT, hyperthyroidism occurred 3 years after the first BMT. He was treated with methimazole. Case 2: A 15-year-old boy was diagnosed with severe aplastic anemia and underwent transplantation from his HLA-matched sister when 15 years of age. Conditioning regimens consisted of CY + ATG. Prophylaxis against GVHD was used sMTX and CyA. He had no acute and chronic GVHD. Hyperthyroidism occurred 3 years after BMT. After he was followed without treatment for 9 months, we started to treat with methimazole.

Results: Systematic evaluation of thyroid function tests in 156 who underwent BMT and are follow-up at our institute gave a rate of hyperthyroidism at 1.3% in this study.

Conclusion: The clinician should be alert to hyperthyroidism as a possible complication after BMT.

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