Thyroid And Cardiac Functions In Β –thalassemia Children:

Ahmed Mohammed Magdy

Summary99SummaryThirty β-thalassemia patients were included in this study(18 males and 12 females), their age ranging from 9-18 years with a mean of 12.8±2.1 years in euthyroid group and 12.7±3.8 years in hypothyroid group . In addition to 15 healthy children with the same age group as control group with a mean of 14.5±2.9 years.The mean height for age percentile was 17.1±20.2 in euthyroid group , 4.4±3.9 in hypothyroid group and 46.7±25.5 in control group. Short stature was found in 40% of patients(below 5th percentile). The mean weight for age percentile was in 11.6±9.9 euthyroid group , 18.5±21.1 in hypothyroid group and 20.1±15.5 in control group. The mean BMI percentile was 28.8±20.5 in euthyroid group , 37.5±24.6 in hypothyroid group and 43.9±38.7 in control group .There was a high significant difference between good and poorly complient groups regarding serum ferritin, serum TSH (p<0.001)(P<0.01) respectively and significant difference between both groups regarding AST , ALT (p<0.05) . Also there was a significant difference between patients receiving Desferoxamine and those receiving Deferiprone regarding Ht. percentile , AST , ALT (p<0.05).There was no significant difference between patients with splenectomy and those who did not undergo splenectomy.There was a high significant +ve correlation between TSH & both serum ferritin and AST (p<0.01) and a significant +ve correlation between TSH & ALT (p<0.05). There was a significant –ve correlation between TSH & FT4(p<0.05). There was a high significant +veSummary11correlation between serum ferritin & both AST , ALT (p<0.01) (p<0.001) respectively. There was a significant –ve correlation between serum ferritin & FT4(p<0.05).Primary hypothyroidism was found in 13.3% of our patients. There was no statistically significant difference regarding anthropometric measures, including weight percentile, BMI , BMI percentile between hypothyroid , euthyroid and control groups(but there was a statistically significant difference regarding height , height percentile , weight) . There was highly statistical significant difference (p<0.001) between euthyroid, hypothyroid and control groups as regard serum ferritin level. There was highly statistical significant difference (p<0.001) between hypothyroid and control groups as regard ASTand ALT. While there was a statistical significant difference (p<0.05) between euthyroid versus control groups and euthyroid versus hypothyroid groups as regard AST , ALT.FT4 level was lower in hypothyroid (13.1±1.8) than euthyroid patients(16.6±2.1) and in control group it is (17±2.5).there was statistically high significant difference between hypothyroid versus control groups as well as euthyroid versus hypothyroid groups regarding FT4 (p< 0.01).On the other hand TSH level was significantly higher in hypothyroid (7.12±1.3) than euthyroid patients(2.93±0.6) and in control group it was (2.94±0.7). There was highly statistical significant difference between hypothyroid versus control groups and euthyroid versus hypothyroid regarding serum TSH (p<0.001) .Summary10All hypothyroid patients were poorly complient to iron chelators ,and 75% of them receiving Desferoxamine .There was no significant difference between well & poorly chelated patients regarding anthropometric measurements. Regarding laboratory findings , there was high significant difference between them as regard serum ferritin and TSH (p<0.001)(p<0.01) . TSH level was higher in poorly chelated (4.42±2.0μiu/ml)than in well chelated patients(2.8±0.7μiu/ml). Also there was a significant difference between them regarding AST , ALT(p<0.05).All hypothyroid patients were examined by echocardiography and this revealed that patients with B-thalassemia major have abnormal left and right dimensions as well as relaxation abnormalities which may be a reflection of early myocardial damage. The mean LVEDD among cases was (4.5±0.8) . The mean LVESD was (3.1±0.6) . The mean LVM was (125±23.2). Also the mean EF among cases was (61±7.7) . The mean pulmonary acceleration time among cases was (100.5±15.2) . There was 1 case with reversed tricuspid E/A ratio indicating right ventricular diastolic dysfunction. There was high significant +ve correlation between serum ferritin and all of LVEDD , LVESD , LVM (p<0.001). Also there was high significant –ve correlation between serum ferritin and both EF and pulmonary acceleration time (p<0.001).