Elevated serum ferritin levels > 3,000 μg/L are highly associated with endocrinopathies among thalassemia patients

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Sasinee Hantrakool Adisak Tantiworawit Lalita Norasetthada Ekarat Rattarittamrong Chatree Chai-adisaksopa Mattabhorn Phimphilai Somdet Srichairattanakool Kanda Fanhchaksai Pimlak Charoenkwan

Abstract

Background: Endocrinopathies are well recognized serious complications among thalassemia patients with iron overload. The predicting serum ferritin level for endocrinopathies has not been determined.


Objective: The study aimed to evaluate the correlation between serum ferritin levels and endocrinopathies among thalassemia patients.


Materials and Methods: This study employed a cross-sectional design. All patients with thalassemia, age >18 years were enrolled between August 2011 and December 2012. Fasting blood sugar, thyroid and gonadal functions were evaluated. Serum ferritin, non–transferrin binding iron (NTBI) and labile plasma iron (LPI) were measured simultaneously.


Result: In all, 118 patients with thalassemia with a median age of 28 years (18-71) were enrolled. The majority of patients presented β-thalassemia/hemoglobin E (49.2%), followed by homozygous β-thalassemia (28.8%) and hemoglobin H disease (20.3%). Most patients (58.5%) underwent splenectomy while two thirds (62.7%) were transfusion dependent thalassemia (TDT). The mean spot and maximum ferritin levels were 2,379 μg/L (279-9,817) and 4,914 μg/L (279-37,656), respectively. The prevalence of diabetes mellitus, hypothyroidism, subclinical hypothyroidism and hypogonadism were 11.9%, 7%, 23.5% and 34.8%, respectively. NTBI correlated well with LPI, serum iron and transferrin saturation. The maximum ferritin level of > 3,000 μg/L was independently associated with diabetes [OR 9.94 (95%CI: 1.34-79.27), p = 0.004], hypothyroidism [OR 3.73 (95%CI: 1.51-9.20), p = 0.003] and hypogonadism [OR 3.54 (95%CI: 1.63-7.69), p = 0.001].


Conclusion: A high prevalence of endocrinopathies was found among adults with thalassemia. The maximum ferritin level of > 3,000 μg/L proved a major risk factor of developing diabetes, hypothyroidism and hypogonadism.

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นิพนธ์ต้นฉบับ (Original article)

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