Abstract
Recently, Garnick et al. (New Engl.J.Med., 1979, 301,252) observed transient thyroxine-binding-globulin (TBG) deficiency in adults during asparaginase therapy. We have studied 6 children with acute lymphoblastic leukemia who were treated with a combination of L-asparaginase, prednisolone, vincristine and daunomycin for inducing remission. Thyroid function was monitored by measuring total thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), TSH and TBG with specific RIA. Within 3 weeks T4 fell rapidly from 10.4 ± 1.9 (mean ± SD) to 3.3 ± 2.6/ug/100 ml, FT4 from 1.7 ± 0.55 to 1.0 ± 0.5 ng/100 ml, T3 from 1.0 ± 2.7 to 0.26 ± 0.04 ng/ml and TBG from 28.2 ± 1.9 to 9.4 ± 5.2/ug/ml. TSH exhibited only a moderate decrease within normal limits. While on a maintenance therapy (cyclophosphamide, cytosine arabinoside and 6-mercaptopurine) these values became normal within 2 to 3 weeks. In 2 of 5 patients FT4 was extremely low (< 0.3 and 0.7 ng/100 ml) which is not sufficiently explained by a transient deficiency of TBG. We speculate that some patients might suffer from a special form of transient hypothyroidism during asparaginase therapy caused by acute inhibition of TSH and/or TRH synthesis.
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Heidemann, P., Peters, HH. & Stubbe, P. Transient reduction in TBG, FT4, T4 and T3 during asparaginase therapy in children. Pediatr Res 15, 75 (1981). https://doi.org/10.1203/00006450-198101000-00026
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DOI: https://doi.org/10.1203/00006450-198101000-00026
