[kitkat67]

Thyroid function "consistent with MGUS"?

by kitkat67 on Fri Apr 06, 2018 11:41 am

Hi,

This is my first post, and I am afraid I don't have much to tell you as far as my diagnosis almost 4 years ago. I was told I have MGUS and sent to a hematologist. After listening to him for awhile, he said we can do a bone marrow biopsy now, or we can wait. I chose to have one. And that's the last of it.

I think I may have been in a fog because I can't remember much about my values from lab tests. He never called for a follow-up after my biopsy, so I just put the whole thing to the side. That's not to say it hasn't been lurking in the background of my every waking thought! But, I have a real bad back and have been seeing a pain specialist for my pain for about 6 years. I have arthritis of the spine, and many other things pain related.

I have been reading this forum off and on for a couple of months, and a few things have popped out at me. One was bone pain, which I had been experiencing in my thighs for almost 6 months. And then hip pain, which is why I had an x-ray recently on my hip (everything normal) and subsequent steroid shots in the bursa and hip. Another is a lump on my hand, actually at the root of my first finger, that grew quickly and has been there for about a year.

Anyway, I was due for my annual exam, and I voiced concern to my doctor about the MGUS diagnosis, saying that I haven't seen anyone in 4 years. So he set me up with a different hema­tolo­gist and ordered some new labs, including a 24-hour urine test. My appointment is in 12 days. Meanwhile my tests came back normal, except for my thyroid, which I was told is con­sistent with my MGUS diagnosis; my doctor recommends a visit to hematologist as discussed on the visit.

I am wondering what is it with my thyroid function that is "consistent with MGUS"? I haven't really heard anything about that before.

Thanks for reading this very long post!!

[Multibilly]

Re: Thyroid function "consistent with MGUS"?

by Multibilly on Fri Apr 06, 2018 3:06 pm

Hi Kitkat,

Hypothyroidism tends to be a bit more common in patients with MGUS, but the condition is certainly not a given in MGUS patients. See the ASH 2015 abstract that I've included below:

You might also find this earlier Myeloma Beacon survey to be of interest.

I'm therefore guessing that if your doctor ran a basic thyroid panel, that your thyroid stimulating hormone (TSH) level might be running a bit high (if you are hypothyroid and your thyroid isn't functioning efficiently, your body tends to produce more TSH than usual in its attempt to boost or keep your T3 and T4 hormones at normal levels).

Have you ever had a thyroid panel run before? As you can see from the survey results above, MGUS patients tended to have been diagnosed with hypothyroidism well before their MGUS diagnosis (this includes me as a smoldering patient).

If you don't have the results of all of your various lab tests in hand, you should ask your doctor's office for copies of them. Same goes for your bone marrow biopsy results. They are your property.

ASH Abstract - Reference

Maltezas, D, et al, "Study of MGUS-Series: Disease Evolution, Coexistant Disorders and Other Clinical Observations," ASH 2015 Annual Meeting Abstract #5323 (link to abstract)

Abstract

Introduction: Monoclonal Gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell disorder occurring mainly in the elderly pop­u­lation. Its evolution, association with various diseases and behavior is an interesting study field in an attempt to understand its pathogenesis and disease course.

Aim: To study the grade of coexistence of non-malignant and malignant diseases along with disease evolution and behavior in patients with MGUS, diagnosed in a single center.

Patients and methods:We studied 138 MGUS-patients that were diagnosed in our center and then followed up to a median of 36 months (6months - 22 years). Median age was 66 years (27-92 years). 57% were of female sex. Monoclonal heavy chain was IgG in 76%, IgA in 14% and IgM in 10% of the patients while 63% presented k-chain clonality. Non-malignant and malignant preexisting diseases were documented at the time point of MGUS-Diagnosis. Patients with B-NHL expressing monoclonal Protein were not classified as MGUS since malignant B-Lymphocytes can be responsible for its production.

Results: 10.9% of the patients presented solid tumors. The most common malignancy was Prostate-Cancer in 8.5% of the male patients followed by Thyroid-Cancer which was present in 2.2% of the whole patient group.Hematological malignancies were existent in 10.9% of the patients. 4.3% presented myelo­proliferative neoplasms while myelo­dys­plastic syndromes were represented in 5% of the patients.18.1% of the patients presented with diverse benign tumors, 8% had been diagnosed with Diabetes Mellitus while 32.6% presented cardio­vascular disease, mainly hypertension (23.2%). Hyper­lipidemia was present in 8.7%. Finally 18.1% of the patients presented non-malignant thyroid disease, mainly hypothyroidism (10.9%) which is increased compared to the general population.17 MGUS-Patients (12%) presented disease evolution. 3 Patients evolved directly to multiple myeloma while 3 more evolved initially to smoldering myeloma (SMM) before developing overt myeloma. 8 patients evolved to SMM without any further progression. 2 patients with IgM-MGUS presented Waldenström's maro­globu­li­nemia in the follow up while one patient developed a B-NHL. We performed a statistical analysis, where only abnormal serum free light chain ratio (sFLCR) was found to have a prognostic impact on MGUS-progression (p=0.03).Within this group of evolving MGUS-patients two of them presented a very remarkable course. The first one was diag­nosed with MGUS while she was in remission after Hodgkin's Lymphoma. She evolved then to SMM confirmed by bone marrow biopsy with more than 10% plasma cell infiltration by immuno­histo­chemistry. After being stable for several months, monoclonal protein was no longer detectable and plasma cells in the bone marrow were normal without any treatment. The second patient was initially diagnosed with MGUS with a high sFLCR of 60. She then evolved to SMM with further sFLCR-increase up to 100 but remained without treatment according to the guidelines at that time. Four years later she developed anemia and the final diagnosis was B-NHL.

Conclusion: In our study group MGUS was associated with numerous malignant and non-malignant disorders. Hypo­thyroidism was a common finding, increased compared to the general popu­lation. MGUS-evolution was also observed however disease course was unexpected in some patients showing the heterogeneity of the disease. sFLCR was confirmed as a prog­nostic factor. Further study is necessary to investigate any possible impli­ca­tion of the above findings in the disease patho­genesis and course.

Disclosures Kyrtsonis: Genesis: Honoraria; Millenium: Research Funding; Lilly: Research Funding; Amgen: Research Funding.

[robinblessed54]

Re: Thyroid function "consistent with MGUS"?

by robinblessed54 on Fri Apr 06, 2018 10:27 pm

I had Hashimoto's thyroiditis for many years before MGUS diagnosis. I also had breast cancer. Before my bone marrow biopsy and MGUS I had IgA deficiency, which led to the other tests for multiple myeloma.

Thanks for listening,
Robin