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<p>Transfusion-dependent thalassemia (TDT) is characterized by chronic iron overload and persistent oxidative stress, which contribute to progressive endocrine dysfunction and long-term morbidity. Although the prevalence of individual endocrine abnormalities has been widely reported, limited data exist on the mechanistic interplay between oxidative stress biomarkers, iron burden, chelation therapy response, and multi-axis endocrine impairment, particularly in comparison with healthy controls.To evaluate oxidative stress profiles in TDT patients, assess the impact of different chelation regimens on oxidative and iron overload parameters, and determine the predictive value of oxidative stress biomarkers for early endocrine axis dysfunction in comparison with healthy controls.This prospective observational and comparative study was conducted over an 18-month period at a tertiary care teaching hospital in North India. A total of 53 TDT patients and 29 age- and sex-matched healthy controls were enrolled as part of a structured oxidative stress and endocrine substudy embedded within a larger institutional cohort. Serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase, and total antioxidant capacity (TAC) were quantified alongside serum ferritin and endocrine parameters assessing thyroid, growth, pubertal, and glucose metabolism axes. Patients were stratified according to chelation regimen (deferasirox, deferoxamine, or combination therapy). Statistical analyses included intergroup comparisons, correlation analysis, and multivariate regression modeling to identify independent predictors of endocrine dysfunction.TDT patients demonstrated significantly higher MDA levels and reduced antioxidant enzyme activity compared with healthy controls (<i>p</i> &lt; 0.001). Combination chelation therapy was associated with lower serum ferritin levels and improved antioxidant profiles relative to monotherapy (<i>p</i> &lt; 0.05). Oxidative stress markers correlated significantly with serum ferritin and multiple endocrine parameters, including TSH, growth velocity, pubertal staging, and fasting plasma glucose. Elevated MDA and reduced TAC emerged as independent predictors of early endocrine dysfunction on multivariate analysis.Oxidative stress plays a central role in mediating iron-induced multi-axis endocrine dysfunction in TDT. Oxidative biomarkers, particularly MDA and TAC, may serve as early predictive indicators of endocrine impairment and therapeutic response, supporting their integration into routine monitoring and chelation optimization strategies.</p>

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Prevalence and Clinical Profile of Thyroid Dysfunction in Transfusion-Dependent Thalassemia: A Prospective Observational Study in a Tertiary Care Center

  • 期刊论文

  • 发表日期：

    2026年6月22日

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  • Sanjay Mishra,
  • Aashi Singhal,
  • Neetu Mishra,
  • Saurabh Shukla,
  • Bhupendra Singh,
  • Nishant Verma

摘要

Transfusion-dependent thalassemia (TDT) is characterized by chronic iron overload and persistent oxidative stress, which contribute to progressive endocrine dysfunction and long-term morbidity. Although the prevalence of individual endocrine abnormalities has been widely reported, limited data exist on the mechanistic interplay between oxidative stress biomarkers, iron burden, chelation therapy response, and multi-axis endocrine impairment, particularly in comparison with healthy controls.To evaluate oxidative stress profiles in TDT patients, assess the impact of different chelation regimens on oxidative and iron overload parameters, and determine the predictive value of oxidative stress biomarkers for early endocrine axis dysfunction in comparison with healthy controls.This prospective observational and comparative study was conducted over an 18-month period at a tertiary care teaching hospital in North India. A total of 53 TDT patients and 29 age- and sex-matched healthy controls were enrolled as part of a structured oxidative stress and endocrine substudy embedded within a larger institutional cohort. Serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase, and total antioxidant capacity (TAC) were quantified alongside serum ferritin and endocrine parameters assessing thyroid, growth, pubertal, and glucose metabolism axes. Patients were stratified according to chelation regimen (deferasirox, deferoxamine, or combination therapy). Statistical analyses included intergroup comparisons, correlation analysis, and multivariate regression modeling to identify independent predictors of endocrine dysfunction.TDT patients demonstrated significantly higher MDA levels and reduced antioxidant enzyme activity compared with healthy controls (p < 0.001). Combination chelation therapy was associated with lower serum ferritin levels and improved antioxidant profiles relative to monotherapy (p < 0.05). Oxidative stress markers correlated significantly with serum ferritin and multiple endocrine parameters, including TSH, growth velocity, pubertal staging, and fasting plasma glucose. Elevated MDA and reduced TAC emerged as independent predictors of early endocrine dysfunction on multivariate analysis.Oxidative stress plays a central role in mediating iron-induced multi-axis endocrine dysfunction in TDT. Oxidative biomarkers, particularly MDA and TAC, may serve as early predictive indicators of endocrine impairment and therapeutic response, supporting their integration into routine monitoring and chelation optimization strategies.