Thyrotoxicosis following cord blood cell transplantation for adult T-cell leukemia/lymphoma

Abstract

A 60-year-old woman underwent cord blood transplantation (CBT) for a second remission of adult T-cell leukemia/lymphoma (ATLL).At about day +80 after CBT, the patient presented with clinical symptoms of thyrotoxicosis. Her level of free thyroxine was >7.7 ng/dL, free triiodothyronine was >32.5 pg/mL, thyroid stimulating hormone was <0.1 μU/mL, and the level of autoantibody against thyroglobulin was 546 IU/ml. A 99m-technetium scintigraphy revealed markedly decreased thyroid uptake, indicating the destruction of thyroid tissue that led to release of preformed hormone into the circulation. The clinical symptoms resolved within　14 days of treatment with propranolol and prednisolone, and levels of thyroid hormones declined rapidly, within 14 days. A combination of toxic and immune-mediate thyroid injuries associated with CBT was apparently involved in the development of thyrotoxicosis. We believe that this is the first report of thyrotoxicosis occurring after CBT for the treatment of ATLL.