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The prevalence of hypoparathyroidism among patients with major thalassemia aged above 10 years

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Author(s): KM Zandian | AM Mohammadian Nasab | K Riahy | H Shahbazian | F Khoshhal Dehder | MR Ashrafi | N Salajaghah

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 15;
Issue: 2;
Start page: 157;
Date: 2005;
Original page

Keywords: Major thalassemia | PTH | trousseau | Ferritin

ABSTRACT
Background: Major Thalassemia is a chronic hemolytic anemia. It is the most common hemoglobinophathy disorder in Khuzestan province. Hypoparathyroidism is one of its endocrinologic complications due to Iron deposition especially in the second decade of life. Early diagnosis of this complication could prevent other sever disorders such as seizures, osteopenia, and osteoporsis. Methods: In a cross sectional study, 96 patients with major thalassemia at the age above ten years referred to Shafa Thalassemia Center, Ahwaz, in addition information about age, sex, weight, height, duration and route of desferral injection, duration of transfusion therapy, vitamin D and calcium consumption, social and educational level of parents, history of splenectomy, any history of seizures, tingling, chvostek, trousseau, carpopedal signs, plasma level of calcium, phosphorus, alkaline phpsphatase, PTH, BUN, Cr, ferritin, and total protein were obtained using questionnaires. Findings: In ninety–six patients with major thalassemia the prevalence of hypoparathyroidism was %27/1 in 11-39 year- olds (average 19.3 years). All patients had low serum calcium, PTH, high serum phosphorus and low to normal alkaline phosphatase. In 26 patients with hypoparathyraidism, 46% had tingling, 38.4% positive chvostek, 30.7% positive trousseau and 11.5% carpopedal spasm. 69.2% of the patients had only sign, whereas 30.8% showed clinically no signs. The average level of serum ferritin in thalassemia patients without hypoparathyroidism was 2770 ng/ml, in hypoparathyroid patients 5020 ng/ml. From 10 patients with irregular desferral consumption 7 patients had overt hypoparthyroidism. Significant correlation was seen between irregular desferral consumption, high ferritin level and hypoparathyroidism. Conclusions: Screening for hypoparathyroidism is recommended in children with major thalassemia aged above 15 years once every 6 months or yearly with measurement of plasma level of PTH, Ca and alkaline phosphatase.
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