Comparison between mean serum ferritin levels and mean serum TSH levels in patients of beta thalassemia major

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1 Iteratioal Joural of Advaced Biotechology ad Research (IJBR) ISSN , Olie ISSN X, Vol-9, Issue-2, 2018, pp Research Article Compariso betwee mea serum ferriti levels ad mea serum TSH levels i patiets of beta thalassemia major 1 Zahid Waseem, 2 Muhammad Dilawar ad 3 Arzoo sajjad 1 Medical Officer, Govt. KotKhawaja Saeed Hospital Lahore 2 Medical Officer, BHUMachoraDistrict adtehseelnakaashab 3 Woma House Officer, Sir Gaga Ram Hospital Lahore ABSTRACT Objective: To compare mea serum ferriti levels with mea serum TSH levels i patiets of beta thalassemia major. Material ad methods: This cross sectioal study was coducted at Departmet of Pediatric Medicie, Govt. Kot Khawaja Saeed Hospital Lahore from Jauary 2017 to Jue Total 66 patiets with Patiets with β thalassemia major were selected. Results: age of the patiets was 8.73 ± years ad meas duratio of blood trasfusio was 7.88 ± years, mea serum TSH was ± µiu/ml, mea serum ferriti was ± g/dl. Negative correlatio betwee serum TSH ad serum ferriti level was oted which was statistically isigificat (r = , P= 0.911). Coclusio: Results of this study revealed that there is egative correlatio betwee serum TSH ad serum ferriti levels which was statistically isigificat. Results of this study also showed isigificat differece betwee mea serum TSH ad mea serum ferriti levels of male ad female patiets was observed. Key words: Iro overload, β thalassemia major, Serum ferriti level, Correlatio, TSH INTRODUCTION The thalassaemias are a heterogeeous group of disorders with a geetically determied reductio i the rate of sythesis of oe or more types of ormal haemoglobi polypeptide chai. I β thalassaemia the iadequate productio of b chai leads to a reductio i the amout of Hb-A i the red cells. 1,2 Patiets with talassemia Major require multiple blood trasfusios. Frequet blood trasfusio ca lead to iro overload which may result edocrie dysfuctio. 3-5 Iro ca deposit i vital orgas such as heart, thyroid, goad, ad pituitary. Oe of the edocriopathy is hypothyroidism. Hypothyroidism classify to subcliical hypothyroidism that TSH level is oly modestly elevated ad free T4 level remais i ormal rage. Primary hypothyroidism is characterized by a elevated TSH level ad decreased (low) T4. Secodary or cetral hypothyroidism characterized by decreased T4 ad low TSH. 5,6 Garadah TS et al. 7 i their study reported that higher serum TSH levels of the patiets of β thalassemia major correlated positively with the levels of serum Ferriti (r=0.34, p=0.014) implyig the lik betwee the two. Some studies coducted i the south Asia regio demostrate that prevalece of hypothyroidism i β thalassemia major varies accordig to the regio, quality of maagemet ad treatmet protocols, thus questioig the lik betwee hypothyroidism ad iro overload. 8

2 The purpose of this study is to fid out the correlatio betwee serum Ferriti levels ad serum TSH levels. Results of this study may guide us for the early maagemet of hypothyroidism i blood trasfusio depedet Beta Thalassemia Major Patiets. OPERATIONAL DEFINITIONS β thalassemia major: Patiet was labelled as patiet of β thalassemia major whe Hb<7gm/dl,microcytichyochromic aemia o peripheral blood picture ad have >70% HbF o hemoglobi electorpholysis with hepatospleomegaly(o cliical basis). serum ferriti level: It was measured i g/dl. TSH level: It was measured i µiu/ml. METHODS AND MATERIALS This cross sectioal study was coducted at Departmet of Pediatric Medicie, Govt. Kot Khawaja Saeed Hospital Lahore from Jauary 2017 to Jue Total 66 patiets with Patiets with β thalassemia major were selected. Iclusio Criteria 1. Patiets with β thalassemia major as per operatioal defiitio. 2. Patiets o blood trasfusio from last 5 years. 3. Age betwee 6 to 15 years. 4. Both male ad female. 5. Patiets takig 1-3 trasfusios/moth. Exclusio Criteria 1. Patiets udergoig boe marrow trasplat 2. Previous history of ay chemotherapy or radiotherapy. 3. Ay history of goiter. 4. Ay history of thyroxie itake. 5. H/O drug or alcohol abuse. 6. Patiets with severe hepatic, real or CVS dysfuctio. 7. Ay history of maligacy. Data Collectio Procedure: Blood samples were draw from the patiets before they udergo their curret scheduled trasfusio. serum Ferriti ad mea serum TSH levels were determied by chemilumiescece method o hormoe aalyzer Cobas e 411 by Roche i the laboratory. All patiets were give same stadard treatmet. All the data was recorded o the specially desiged Performa. Data aalysis Data was aalyzed usig SPSS versio 22. Quatitative data like age, duratio of blood trasfusio, TSH, Ferriti levels ad qualitative data like geder was aalyzed. ad stadard deviatio was calculated for quatitative data like age ad duratio of blood trasfusio. Frequecy ad percetages were calculated for aalysis of qualitative data like geder. Pearso correlatio coefficiet was calculated for mea serum TSH ad mea serum Ferriti levels. Effect Modifiers like age, duratio of blood trasfusio ad geder were cotrolled by Stratificatio. Post Stratificatio T test was applied. P value 0.05 was cosidered as sigificat. RESULTS age of the patiets was 8.73 ± years ad mea duratio of blood trasfusio was 2.91 ± years, mea serum TSH was ± µiu/ml, mea serum ferriti was ± g/dl. Table 1 showig relatio of serum TSH level with serum ferriti. The Pearso correlatio test showed that the level of serum TSH decreased with icreasig serum ferriti levels. This egative correlatio was statistically isigificat (r = , P= 0.911). serum TSH i male ad female patiets was ± µiu/ml ad ± µiu/ml respectively. Compariso of mea serum TSH betwee male ad female patiets was doe ad isigificat (P = 0.956) differece betwee mea TSH of male ad female patiets was oted. (Table 2) serum ferriti leveli male ad female patiets was ± g/dl ad ± g/dl respectively. Compariso of mea serum ferriti levelbetwee Zahid Waseem, et al. 8

3 male ad female patiets was doe ad isigificat (P = 0.155) differece betwee serum ferriti levelof male ad female patiets was oted. Patiets were divided ito two age group, age group 6-10 years ad age group years. serum TSH i age group 6-10 years was ± µiu/ml ad i age group years was ± µiu/ml. But the differece betwee mea TSH of both age groups was statistically isigificat with p value (Table 3) Patiets were divided ito two age group, age group 6-10 years ad age group years. serum ferriti leveli age group 6-10 years was ± g/dl ad i age group years was ± g/dl. But the differece betwee serum ferriti levelof both Table 1: Correlatio of serum TSH with serum ferriti TSH Pearso correlatio (r) P-value serum ferriti (g/dl) age groups was statistically isigificat with p value Divisio of patiets accordig to duratio of blood trasfusio was doe ad two groups were made 1-3 year group ad 4-5 years group. TSH i 1-3 year group was ± µiu/ml i 4-5 years group mea TSH was ± µiu/ml. isigificat (P = 0.343) differece betwee the mea TSH of both group was oted. (Table 4) Divisio of patiets accordig to duratio of blood trasfusio was doe ad two groups were made 1-3 year group ad 4-5 years group. serum ferriti level i 1-3 year group was ± g/dl i 4-5 years group mea serum ferriti levelwas ± g/dl. Isigificat (P = 0.988) differece betwee the mea serum ferriti level of both group was oted. Table 2: Compariso of mea TSH ad mea serum ferriti level betwee male ad female patiets Geder Std. Deviatio P Value TSH level Male Female serum ferriti level Male Female Table 3: Compariso of mea TSH ad serum ferriti level betwee differet age groups Age Group Std. Deviatio mea TSH level ferriti level P Value Table 4: Compariso of mea TSH ad serum ferriti level for duratio of blood trasfusio Duratio of blood trasfusio Std. Deviatio P Value TSH level Mea ferriti level Zahid Waseem, et al. 9

4 DISCUSSION Thyroid hormoes are importat for the proper developmet, differetiatio ad metabolism of cells. Thyroid dysfuctio has bee reported i a umber of studies o thalassemia patiets. A wide rage of pathogeic mechaisms may be ivolved. Tissue chroic hypoxia ad iro overload have a direct toxic effect o the thyroid glad 9. High cocetratios of labile plasma iro ad labile cell iro may lead to the formatio of free radicals ad the productio of reactive oxyge species resultig i cell ad orga damage 10. I severe iro overloaded thalassemic patiets the aterior pituitary may also be damaged ad regulatory hormoal secretio (LH, FSH, ad TSH) may be disrupted 11. Orga siderosis (liver, cardiac ad skeletal muscle, kidey) may affect specific receptors, which regulate thyroid hormoe actio ad covert T4 to the bioactive T3. I preset study mea age of thalassemic patiets was 8.73 ± years, mea serum TSH was ± µiu/ml, mea serum ferriti was ± g/dl. I oe study Malik et al 12 mea age of thalassemic patiets was 7.6 ± 2.5 years which is comparable with our study. Similar mea age (7.65 ± 3.61) of thalassemic patiets was also reported by Karim et al 13 i their study. I preset study male patiets were 65% ad female patiets were 35%. Similar results were reported by Karim et al 13 i their study. Solaki et al 14 reported mea serum TSH ad mea serum ferriti as 7.14±9.04 ad ± which is comparable with the fidigs of my study. I preset study egative correlatio was oted betwee serum TSH ad serum ferriti which was statistically isigificat (r = , P= 0.911). Solaki et al 14 also reported that there was o correlatio betwee serum TSH ad serum ferriti level (P-value= 0.38). Farooq MS et al 15 also reported egative correlatio betwee serum ferriti ad serum TSH which was statistically isigificat. Garadah TS et al 16 i their study reported that higher serum TSH levels of the patiets of β thalassemia major correlated positively with the levels of serum Ferriti (r=0.34, p=0.014) results of this sudy are ot supportig my study. Eshragi et al 4 also reported a Correlatio betwee TSH ad serum ferriti level which was ot sigificat (p=0.584) I preset study mea serum TSH i male ad female patiets was ± µiu/ml ad ± µiu/ml respectively. Compariso of mea serum TSH betwee male ad female patiets was doe ad isigificat (P = 0.956) differece betwee mea TSH of male ad female patiets was oted. Farooq MS et al 15 mea serum TSH i male ad female patiets as 3.67± 0.69 ad 4.73± 1.20 ad the differet statistically isigificat p value Fidigs of this study are comparable with our fidigs. I preset study mea serum ferriti leveli male ad female patiets was ± g/dl ad ± g/dl respectively ad isigificat (P = 0.155) differece betwee serum ferriti levelof male ad female patiets was oted. Irshaid et al 17 reported serum ferriti level i male ad female patiets as 2699 ± 858 ad 2412 ± 750 which is comparable with my study. CONCLUSION: Results of this study revealed that there is egative correlatio betwee serum TSH ad serum ferriti levels which was statistically isigificat. Results of this study also showed isigificat differece betwee mea serum TSH ad mea serum ferriti levels of male ad female patiets were observed. REFERENCES 1. Malik SA, Syed S, Ahmed N. Frequecy of hypothyroidism i patiets of betathalassaemia. J Pak Med Assoc. 2010;60(1): Merchat RH, Shirodkar A, Ahmed J. Evaluatio of growth, puberty ad edocrie Zahid Waseem, et al. 10

5 dysfuctios i relatio to iro overload i multi trasfused Idia thalassemia patiets. Idia J Pediatr. 2011;78(6): Kurtoglu AU, Kurtoglu E, Temizka AK. Effect of iro overload o edocriopathies i patiets with beta-thalassaemia major ad itermedia. Edokryol Pol. 2012;63(4): Eshragi P, Tamaddoi A, Zarifi K, Mohammadhasai A, Amizadeh M. Thyroid fuctio i major thalassemia patiets: Is it related to height ad chelatio therapy? Caspia J Iter Med. 2011;2(1): Abdel-Razek AR, Abdel-Salam A, El- Sobaty MM, Youess ER. Study of thyroid fuctio i Egyptia childre with betathalassemia major ad beta-thalassemia itermedia. J Egypt Public Health Assoc. 2013;88(3): Garadah TS, Mahdi NA, Jaradat AM, Hasa ZA, Nagalla DS. Thyroid fuctio status ad echocardiographic abormalities i patiets with Beta thalassemia major i Bahrai. Cli Med Isights Cardiol. 2013;7: Piriccioglu AG, Deiz T, Gokalp D, Beyazit N, Haspolat K, Soker M. Assessmet of thyroid fuctio i childre aged 1-13 years with Beta-thalassemia major. Ira J Pediatr. 2011;21(1): Wahab S, Kha RA, Ahmad K, Wahab A, Ahmad I. ExtramedullaryHaematopoiesis Causig Spial Cord Compressio i a Thalassemia Itermedia Patiet. Nepalese Joural of Radiology Mar 3;2(2): Magro S, Puzzoia P, Cosario C, Galati MC, Morgioe S, Porcelli D, Grimaldi S, Tacrè D, Arcuri V, De Satis V (1990). Hypothyroidism i patiets with thalassemia sydromes. Acta Haematol.1990; 84: Esposito BP, Breuer W, Sirakapracha P, Pootrakul P, Hershko C, Cabatchik ZI. Labile plasma iro i iro overload: redox activity ad susceptibility to chelatio. Blood. 2003; 102(7): Cavallo L, Licci D, Acquafredda A, Marrazii M, Beccasio R, Scardio ML, Altomare M, Mastro F, Sisto L, Schettii F. Edocrie ivolvemet i childre with betathalassaemia major. Trasverse ad logitudial studies. I. Pituitary-thyroidal axis fuctio ad its correlatio with serum ferriti levels, ActaEdocriol (Copeh). 1984; 107(1): Malik SA, Syed S, Ahmed N. Frequecy of hypothyroidism i patiets of betathalassaemia. J Pak Med Assoc. 2010;60(1): Karim AR, Islam MR, Deeba F, Fakir MHJ, Mati A. Correlatio of Thyroid Hormoe Deragemet with Serum Ferriti Level i Childre with Beta Thalassaemia Major at a Tertiary Care Hospital of Bagladesh. J ShaheedSuhrawardy Med Coll, 2013;5(2): Solaki US, Bhargava AK, Adole PS. ASSESSMENT OF THYROID FUNCTION IN MULTI-TRANSFUSED CHILDREN OF β THALASSEMIA MAJOR WITH IRON OVERLOAD [cited 2016 Jul 24]; Available from: pdf. 15. Farooq MS, Asif M, Shahee B, Mazoor Z. Serum Ferriti Level i Thalassemic Patiets of Years ad its Relatioship with Thyroid Fuctio Tests. Med. Forum. 2014;25(11): Garadah TS, Mahdi NA, Jaradat AM, Hasa ZA, Nagalla DS. Thyroid fuctio status ad echocardiographic abormalities i patiets with Beta thalassemia major i Bahrai. Cli Med Isights Cardiol. 2013;7: Irshaid F, Masi K. Status of thyroid fuctio ad iro overload i adolescets ad youg adults with beta-thalassemia major treated with deferoxamie i jorda. I: Proceedigs of World Academy of Sciece, Egieerig ad Techology [Iteret] [cited 2016 Jul 27]. p Available from: 8/Status_of_thyroid_fuctio_ad_iro_over yq.pdf Zahid Waseem, et al. 11