Thyroid dysfunction among long-term survivors of bone marrow transplantation

      This paper is only available as a PDF. To read, Please Download here.


      Thyroid function studies were followed serially in 27 long-term survivors (median 33 months) of bone marrow transplantation. There were 15 men and 12 women (median age Math Eq years, range Math Eq to Math Eqyears). Aplastic anemia (14 patients) and acute nonlymphocytic leukemia (eight patients) were the major reasons for bone marrow transplantation. Pretransplant conditioning consisted of single-dose irradiation combined with high-dose, short-term chemotherapy in 23 patients, while four patients received a bone marrow transplantation without any radiation therapy.
      Thyroid dysfunction occurred in 10 of 23 (43 percent) irradiated patients; compensated hypothyroidism (elevated thyroid-stimulating hormone levels only) developed in eight subjects, and two patients had primary thyroid failure (elevated thyroid-stimulating hormone levels and low T4 index). The abnormal thyroid studies were detected a median of 13 months after bone marrow transplantation. The four subjects who underwent transplantation without radiation therapy have remained euthyroid (median follow-up two years). The only variable that appeared to correlate with the subsequent development of impaired thyroid function was the type of graft-versus-host disease prophylaxis employed; the irradiated subjects treated with methotrexate alone had a higher incidence of thyroid dysfunction compared to those treated with methotrexate combined with antithymocyte globulin and prednisone (eight of 12 versus two of 11, p < 0.05). The high incidence and subtle nature of impaired thyroid function following single-dose irradiation for bone marrow transplantation are discussed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Storb R
        • Thomas ED
        • Weiden PL
        • et al.
        Aplastic anemia treated by allogeneic bone marrow transplantation: a report of 49 new cases from Seattle.
        Blood. 1976; 48: 817-841
        • Ramsay NKC
        • Kim T
        • Nesbit ME
        • et al.
        Total lymphoid irradiation and cyclophosphamide as preparation for bone marrow transplantation in severe aplastic anemia.
        Blood. 1980; 55: 344-346
        • Thomas ED
        • Buckner CD
        • Clift RA
        • et al.
        Marrow transplantation for acute non-lymphoblastic leukemia in first remission.
        N Engl J Med. 1979; 301: 597-599
        • Powles RL
        • Clink HM
        • Bandini G
        • et al.
        The place of bonemarrow transplantation in acute myelogenous leukemia.
        Lancet. 1980; I: 1047-1050
        • Johnson FL
        • Thomas ED
        • Clark BS
        • Chard RL
        • Hartmann JR
        • Storb R
        A comparison of marrow transplantation with chemotherapy for children with acute lymphoblastic leukemia in second or subsequent remission.
        N Engl J Med. 1981; 305: 846-851
        • Markson JL
        • Flatman GE
        Myxoedema after deep x-ray therapy to the neck.
        Br Med J. 1965; 1: 1228-1230
        • Glatstein E
        • McHardy-Young S
        • Brast N
        • Eltringhan JR
        • Kriss JP
        Alterations in serum thyrotropin (TSH) and thyroid function following radiotherapy in patients with malignant lymphoma.
        J Clin Endocrinol Metab. 1971; 32: 833-841
        • Shafer RB
        • Nuttall FQ
        • Pollak K
        • Kuisk H
        Thyroid function after radiation and surgery for head and neck cancer.
        Arch Intern Med. 1975; 135: 843-846
        • Schimpff SC
        • Diggs CH
        • Wiswell JG
        • Salvatore PC
        • Wernik PH
        Radiation related thyroid dysfunction: implications for the treatment of Hodgkin's disease.
        Ann Intern Med. 1980; 92: 91-98
        • Kim TH
        • Kersey J
        • Sewchand W
        • Nesbit M
        • Krivit W
        • Levitt SH
        Total body irradiation with a high-dose-rate linear accelerator for bone-marrow transplantation in aplastic anemia and neoplastic disease.
        Radiology. 1977; 122: 523-525
        • O'Leary M
        • Ramsay NKC
        • Nesbit M
        • et al.
        Bone marrow transplantation for childhood non-Hodgkin's lymphoma (NHL).
        in: Proc Am Assoc Cancer Res Am Soc Clin Oncol. 21. 1980: 173
        • Kim TH
        • Kersey JH
        • Khan FM
        • et al.
        Single dose total lymphoid irradiation combined with cyclophosphamide as immunosuppression for human marrow transplantation in aplastic anemia.
        Int J Radiat Oncol Biol Phys. 1979; 5: 993-996
        • Ramsay NKC
        • Kersey JH
        • Robison LL
        • et al.
        A randomized study of the prevention of acute graft-versus-host disease.
        N Engl J Med. 1982; 306: 392-397
        • Steffes MW
        • Oppenheimer JH
        The laboratory evaluation of thyroid function.
        Minn Med. 1979; 62: 162-164
        • Peto R
        • Pike M
        • Armitage P
        • et al.
        Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples.
        Br J Cancer. 1977; 35: 1-39
        • Shalet SM
        • Rosenstock JD
        • Beardwell CG
        • Pearson D
        • Morris Jones PH
        Thyroid dysfunction following external irradiation to the neck for Hodgkin's disease in childhood.
        Clin Radiol. 1977; 28: 511-515
        • Green DM
        • Brecher ML
        • Yakar D
        • et al.
        Thyroid function in pediatric patients after neck irradiation for Hodgkin's disease.
        Med Pediatr Oncol. 1980; 8: 127-136
        • Smith RE
        • Adler RA
        • Clark P
        • Brinck-Johnsen T
        • Tulloh ME
        • Colton T
        Thyroid function after mantle irradiation in Hodgkin's disease.
        JAMA. 1981; 245: 46-49
        • Fuks Z
        • Glatstein E
        • Marsa GW
        • Bagshan MA
        • Kaplan HS
        Long-term effects of external radiation on the pituitary and thyroid glands.
        Cancer. 1976; 37: 1152-1161
        • Nelson DF
        • Reddy KV
        • O'Mara RE
        • Rubin P
        Thyroid abnormalities following neck irradiation for Hodgkin's disease.
        ancer. 1978; 42: 2553-2562
        • Ellis F
        Dose, time and fractionation: a clinical hypothesis.
        Clin Radiol. 1969; 20: 1-7
        • Malone J
        The radiation biology of the thyroid.
        Curr Top Radiat Res. 1975; 10: 263-368
        • Peters L
        Discussion: the radiobiological bases of TBI.
        Int J Radiat Oncol Biol Phys. 1980; 6: 785-787
        • Baxter JD
        • Forsham PH
        Tissue effects of glucocorticoids.
        Am J Med. 1972; 53: 573-589
        • Najarian JS
        • Simmons RL
        • Condie RM
        • et al.
        Seven years experience with antilymphoblast globulin for renal transplantation from cadaver donors.
        Ann Surg. 1976; 184: 352-367
        • Probert JC
        • Parker BR
        • Kaplan HS
        Growth retardation in children after megavoltage irradiation of the spine.
        Cancer. 1973; 32: 634-639