Hypothyroidism and Hypoparathyroidism in Thalassemia Major Patients: A Study in Sistan and Baluchestan Province, Iran

Background: Hypothyroidism (HT) and hypoparathyroidism (HPT) are common endocrine complications in thalassemia major (TM) patients. Objectives: In the present study, we assessed the frequency of HT and HPT in a population of TM patients in Southeast of Iran. Methods: This cross sectional study was performed on 194 TM patients in Zabol, Sistan and Baluchestan Province, Iran, during February - July 2016. The demographic, clinical, and laboratory data were collected via interviews and history - taking. For hormone measurements, specific ELISA kits were used. Statistical analysis was performed in SPSS version 16. Results: A total of 103 (53.1%) and 91 (46.9%) females and males were recruited in this study, respectively. The mean age of the patients was 15 +/- 7.5 years. HT and HPT showed overall frequencies of 8.2% (18/194) and 18% (35/194), respectively. Subclinical and overt HT were observed in 13 (6.7%) and 5 (2.6%) patients, respectively. There was no significant association between HT and age, while patients with HPT were significantly older than those without HPT (20.1 +/- 5.8 vs. 13.9 +/- 6.2 years; P < 0.001). HPT was significantly associated with the mean received blood per transfusion (P = 0.009), total transfused blood per year (P = 0.01), splenomegaly (P < 0.001), splenectomy (P < 0.001), hepatomegaly (P = 0.01), and chelation regimen (P < 0.001). The ferritin level was correlated with neither HT nor HPT. Also, no significant difference was observed between patients with or without HT or HPT regarding the cooccurrence of either diabetes or hepatitis C virus (HCV) infection. In the multivariate analysis, splenectomy remained an independent risk factor for HPT after correction for potential covariates (OR, 6.5; 95% CI, 1 - 39.2; P = 0.04). Conclusions: In patients with TM, HT was a complication with a relatively low frequency, while HPT was more common. Based on the findings, HPT was more frequent in older patients receiving regular blood transfusions, thereby necessitating close monitoring of these patients.