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Parathyroid function in children with beta thalassemia and correlation with iron load

Adel A. Hagag, Mohamed R. El-Shanshory, Amany M. Abo El-Enein

Background: Patients with beta-thalassemia present with severe anemia requiring regular red blood cell transfusions. This can lead to iron overload and its related complications including disorders of the endocrine systems. The aim of this work was to study parathyroid function in children with beta-thalassemia major in correlation with iron load. Methods: 60 patients with beta-thalassemia major were included. The cohort included 32 males and 28 females with an age range of 6-10 years and a control group of 30 healthy children of matched age and sex. All patients underwent complete blood count, Hb electrophoresis, serum iron status, parathyroid hormone (PTH) levels, serum ionized calcium, phosphorus and alkaline phosphatase, and assessment of bone mineral density. Results: Serum ferritin, iron, phosphorus and alkaline phosphatase were significantly higher in children with beta-thalassemia, while serum total iron binding capacity, PTH and ionized calcium were significantly lower in these patients compared to controls. A significant negative correlation was found between serum parathyroid hormone levels and ferritin. Reduced bone mineral density was present in 33 patients (55%), with osteoporosis in 21 patients (35%) and osteopenia in 12 patients (20%). Conclusions: Parathyroid hormone levels are significantly lower in thalassemic patients, with a significant negative correlation with serum ferritin. Regular and continuous follow up of PTH, calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels is recommended for early detection of hypoparathyrodism in thalassemic patients. Regular and continuous bone mineral density assessment is also recommended for early detection of osteoporosis or osteopenia.