Thyroid hormone status in children with transfusion-dependent thalassemia


  • M. Abu Taleb Department of Paediatrics, Khwaja Yunus Ali Medical College and Hospital, Sirajganj, Bangladesh
  • M. Abdur Rouf Department of Paediatrics, MH Samorita Medical College Hospital, Dhaka, Bangladesh
  • Prodip Kumer Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
  • M. Rasel Bhuyan Medical Officer (MCH-FP), Shahzadpur, Sirajgonj, Bangladesh
  • Sumona Khandokar Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
  • M. Fakhrul Alam Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh



Thyroid, Hormone, Children, Transfusion-dependent, Thalassemia


Background: Thalassemia, a prevalent genetic disorder, necessitates recurrent blood transfusions for life, precipitating iron overload and premature death. In β-thalassemia major (BTM), hypothyroidism prevalence fluctuates (6-30%) globally, influenced by diverse chelation regimens. The objective of this study is to evaluate the thyroid hormone levels in pediatric patients diagnosed with transfusion-dependent thalassemia (TDT).

Methods: A hospital-based cross-sectional study was conducted at the paediatrics department of Sir Salimullah medical college Mitford hospital, Dhaka, focusing on TDT patients aged 4 to 18 years. Exclusions comprised known cases of hypothyroidism, children receiving hormonal therapy, those with a family history of hypothyroidism, and individuals with fewer than 10 blood transfusions. Serum separation involved centrifugation at 3000 rpm for 5 minutes, with subsequent aliquoting into two screw-capped dry clean vials: 1 ml each for FT4/TSH and serum ferritin estimation. Data were analyzed using SPSS version 24.0.

Results: Eighty-seven transfusion dependent thalassemia children aged between 4 to 18 years were chosen in this study. The hypothyroidism was seen in 7 (8%) patients. Of these, 4 (4.6%) participants were compensated hypothyroid and 3 (3.4%) participants were uncompensated hypothyroid. Most of the participants were hypothyroidism with Hb E-β thalassemia. The mean serum ferritin level was 2578.49±1385.06 ng/ml. Positive correlation of TSH with duration of disease (in years), total number of blood transfusion times and serum ferritin were statistically significant (p<0.05).

Conclusions: The present study demonstrates that 8% of the children with TDT have hypothyroidism. Hypothyroidism is more frequent among Hb E β-thalassemic children as compared to β-thalassemic children.


Rund D, Achmilewitz, E. Thalassemia Maior. J Older Patients, New Therapies. Blood Reviews. 1995;9(1):25-32.

Upadya SH, Rukmini MS, Sundararajan S, Baliga BS, Kamath N. Thyroid Function in Chronically Transfused Children with Beta Thalassemia Major: A Cross-Sectional Hospital Based Study. Int J Pediatr. 2018;1:1-5.

Weatherall DJ The inherited diseases of hemoglobin are an emerging global health burden. Blood. 2010;115(22):4331-6.

Khan WA, Banu B, Amin S, Selimuzzaman M, Rahman M, Hossain B, et al. Prevalence of Beta thalassemia trait and Hb E trait in Bangladeshi school children and health burden of thalassemia in our population. DS (Child) H J. 2005;21(1):1-7.

Gruchy D. Disorder of Hemoglobin Structure and Synthesis, In: Saxena, R. Pati, H.P, Nahapatra, M (eds.). Clinical Hematology in Medical Practice. 6th ed. India: Wiley India pvt. Ltd. 2013;119-37.

Shamshirsaz, Alireza A, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, et al. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocrine Disorders. 2003;3(1):4.

Usman M, Moinuddin M, Ghani R, Usman S. Screening of Five Common Beta Thalassemia Mutations in the Pakistani Population: A basis for prenatal diagnosis. Sultan Qaboos University Med J. 2009;9(3):305-10.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5:11.

Hossain MS, Raheem E, Sultana TA, Ferdous S, Nahar N, Islam S, et al. Thalassemias in South Asia: clinical lessons learnt from Bangladesh. Orphanet J Rare Dis. 2017;12(1):93.

Khan FR. Thalassemia: still a challenge. Gomal J Med Sci. 2006;4(2):47-8.

Satwani H. Endocrinal complications in thalassemia: frequency and association with ferritin levels. Pak Red J. 2005;29(1):113-9.

Borgna-Pignatti C, Rugolotto S, Stefano PD, Zhao H, Cappellini MD. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004;89(10):1187-93.

Jehanzeb K, Ahmad F, Lodhi MA, Ali S. Assessment of Status of Thyroid Function in Patients of β thalassemia Major, Reporting to OPD of Military hospital, Rawalpindi. Pak Armed Forces Med J. 2016;66(6):809-13.

Yassouf MY, Alquobaili F, Kabalan Y, Mukhalalaty Y. Compliance with Deferoxamine Therapy and Thyroid Dysfunction of Patients with β-Thalassemia Major in Syria. Hemoglobin. 2019;43(3):218-21.

Pirinççio AG, Haspolat K, Söker M. Assessment of Thyroid Function in Children Aged 1-13 Years with Beta-Thalassemia Major. Iran J Pediatr. 2011;21(1):77-82.

Chandrashekhar C, Vuyyuru M, Vasudev PH, Mathew Panachiyil G, Babu T. A prospective cross-sectional study of thyroid dysfunction in transfusion- dependent beta-thalassemia patients. Indian J Child Health. 2021;8(5):183-6.

Karim AR, Islam MR, Deeba F, Fakir MHJ, Matin A. Correlation of Thyroid Hormone Derangement with Serum Ferritin Level in Children with Beta Thalassaemia Major at a Tertiary Care Hospital of Bangladesh. J Shaheed Suhrawardy Med College. 2013;5(2):87-90.

Kundu D, Ray D, Ghosh S, Dutta S, Dhar A, Chowdhury DG. Relation of elevated serum ferritin levels to hypothyroidism in children with beta-thalassemia major. Int J Med Res Rev. 2016;4(12):2120-24.

Rahman SA, Jamal CY. Congenital hemolytic anemia in Bangladesh: types and clinical manifestations. Indian Pediatr. 2002;39(6):574-7.

Abdel-Razek ARA, Abdel-Salam A, El-Sonbaty MM, Youness ER. Study of thyroid function in Egyptian children with β-thalassemia major and β-thalassemia intermedia. J Egypt Public Health Asso. 2010;88(3):148-52.

Mahmoud RA, Khodeary Aarhan MS. Detection of endocrine disorders in young children with multi-transfused thalassemia major. Italian J Pediatr. 2021;47(1):165.

Imran A, Wani G, Sing K. Assessment of thyroid profile in children with thalassemia and its correlation with serum ferritin level. Int J Med Heal Res. 2011;4(10):136-8.






Original Research Articles