Assessment of Gonadal and Thyroid Function for Adult Transfusion- Dependent- ?- Thalassemic Patients in Palestine

Abstract

?-thalassemia is an inherited hemoglobin disorder. It is considered as a health problem in Palestine thus, premarital screening for thalassemia became compulsory. The aim of this study was to determine the prevalence and risk factors for hypogonadism and hypothyroidism among Palestinian transfusiondependent ?-thalassemic patients. Across-sectional study was conducted in 2010-2011 which involved ?-thalassemic patients in four Palestinian districts. Sixty one adult (>14 yr) patients, 30 cases and 31 healthy controls, were tested for gonadal and thyroid function tests, the first included free testosterone, estradiol, leutinizing hormone (LH) and follicular-stimulating hormone (FSH) while the latter included thyroid-stimulating hormone (TSH), free T3 and free T4. The prevalence of hypogonadism in the case group was 47% compared to 9.6% in the control group which is statistically significant (p<0.005). None of the subjects in the case group suffered from overt hypothyroidism except for two subclinical cases (6.7%) while the control group was completely free from hypothyroidism. The thalassemic patients are significantly shorter and lighter than the controls (P<0.05). The mean hemoglobin level in the case group (8.1 (1.1) g/dl) is significantly lower than a normal cut-off value of 12 g/dl. The mean ferritin level (4260 ng/ml) is significantly higher than the upper limit (282ng/ml). About 47% of the case group is not on chelation therapy and 53% are splenectomized. However, Splenectomy and chelation therapy had no statistical association with hypogonadism (P>0.05).The high rate of hypogonadism and related disturbances reveal the insufficient healthcare the patients are receiving. This puts forward the priority for a close and continuous follow-up for thalassemic patients in Palestine.