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LETTER TO EDITOR
Year : 2008  |  Volume : 4  |  Issue : 2  |  Page : 102-103

The relationship between the thyroid hormone (or its lack) and dysplastic hematopoiesis


Hospital Universitário Walter Cantídio - Division of Hematology - Federal University of Ceará, Brazil

Date of Web Publication1-Aug-2008

Correspondence Address:
SMM Magalhaes
Av. José Bastos 3390, CEP 61 440-261, Fortaleza Ce
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.42263

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How to cite this article:
Magalhaes S, Pinheiro D A, Souza M D, Pinheiro R F. The relationship between the thyroid hormone (or its lack) and dysplastic hematopoiesis. J Can Res Ther 2008;4:102-3

How to cite this URL:
Magalhaes S, Pinheiro D A, Souza M D, Pinheiro R F. The relationship between the thyroid hormone (or its lack) and dysplastic hematopoiesis. J Can Res Ther [serial online] 2008 [cited 2020 Jun 5];4:102-3. Available from: http://www.cancerjournal.net/text.asp?2008/4/2/102/42263

Sir,

We read with interest the report of the clinical study by Akoum et al . on myelodysplastic syndrome and hyperthyroidism. [1] Erythropoiesis is influenced directly or indirectly by many hormones other than erythropoietin. Both hyperthyroidism and hypothyroidism are associated with hematological abnormalities. Untreated thyroid insufficiency can be insidious or subclinical. In these cases anemia is usually mild, may be masked by a decrease in plasma volume, and is probably related to tissue oxygen consumption and arrested red cell production. Iron kinetic abnormalities typical of the anemia of chronic disease have also been documented. [2],[3]

Myelodysplastic syndromes (MDS) are characterized by progressive marrow failure and a tendency for evolution to acute leukemia. Dysplastic hematopoiesis is the cornerstone of diagnosis. In addition, cytogenetic analysis may provide diagnostic and prognostic information. However, dysplastic hematopoiesis is a frequent finding in patients with cobalamin/folate deficiency, HIV infection, kidney and liver failure, and in autoimmune and metabolic diseases, including thyroid dysfunctions. Especially in cases with no excess of blast or clonal cytogenetic abnormality, the diagnosis of MDS requires an extensive exclusion of reversible nonclonal disorders. [4]

In an unselected series of 138 adult patients with MDS, primary hypothyroidism (TSH >10 mU/l; normal range 0.25-4 mU/l) was present on diagnosis in six cases. Anemia was present in all patients. Vitamin B 12 and folate deficiencies were systematically excluded. Cytogenetic analysis was performed in five patients and no clonal abnormalities were detected. The median follow-up period was 7 years (range 1-13 years). Continuous hormone replacement resulted in normalization of TSH; the hemoglobin level rose in all cases but one [Figure 1], although none reached the normal range. Interestingly, the bone marrow analysis performed after at least 6 months of adequate treatment revealed increase in cellularity, more pronounced dysplastic abnormalities involving more hematopoietic lineages and, in two cases, a thickness of reticulin that has not previously been documented.

Anemia is common in hypothyroidism and is considered to be an adjustment to a decreased basal metabolism. It is characterized by reticulopenia, erythroid hypoplasia, and a decreased level of endogenous erythropoietin. [5] It is possible that the thyroid insufficiency, and the consequent arrested hematopoiesis, hinder or prevent the full-blown bone marrow dysplastic features of MDS from manifesting. The replacement treatment, by correcting the hypoproliferative status, makes the dysplastic abnormalities more conspicuous and concomitant MDS more evident, the possible reason for partial or no hemoglobin response. Continued attention to thyroid function therefore seems essential in the diagnosis and management of MDS.

 
 > References Top

1.Akoum R, Michel S, Wafic T, Emille B, Marwan M, Khaled H, et al . Myelodysplastic syndrome and pancytopenia responding to treatment of hyperthyroidism: Peripheral blood and bone marrow analysis before and after antihormonal treatment. J Cancer Res Ther 2007;3:43-6.  Back to cited text no. 1
    
2.Spivak JL. The blood in systemic disorders. Lancet 2000;355:1707-12.  Back to cited text no. 2
    
3.Christ-Crain M, Meier C, Huber P, Zulewski H, Staub JJ, Muller B. Effect of restoration of euthyroidism on peripheral blood cells and erythropoietin in women with subclinical hypothyroidism. Hormones 2003;2:237-42.  Back to cited text no. 3
    
4.Magalhγes SM. Myelodysplastic syndromes-diagnosis by exclusion. Rev Bras Hematol Hemoter 2006;28:175-7.  Back to cited text no. 4
    
5.Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008;29:76-131.  Back to cited text no. 5
    


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