Alterations in Thyroid Hormone Metabolism During Chemotherapy in Patients With Testicular Carcinoma

Abstract

In a prospective study, the effects of chemotherapy on thyroid function in patients with non-seminoma testicular carcinoma were evaluated. Thirty-one patients were studied; in sixteen immunoassayable HCG was present, but altered thyroid function could not be established. In fifteen patients an exaggerated TSH response to TRH was observed. In these patients, although T3 and T4N values were normal, basal TSH levels were higher compared to patients with a normal TSH response, probably due to preceding lymphangiography. During chemotherapy, T4N, T3 and rT3 levels rose significantly, but basal TSH levels and the TSH response to TRH decreased. In contrast, the prolactin responses to TRH increased. The observed changes in thyroid function during chemotherapy appear to result from delayed thyroid hormone clearance, probably caused by an effect of chemotherapy on deiodinating enzyme activity. This would result, in an increase in T4N and rT3 levels and a fall in TSH levels and in the TSH response to TRH. Furthermore, after therapy the raised T4N and lowered TSH levels remained, whilst the FT3 level did not change either during or after therapy, suggesting an unaltered hypothalamic/pituitary axis.

Implication from thyroid function decreasing during chemotherapy in breast cancer patients: chemosensitization role of triiodothyronine

“…And during chemotherapy, T 4 , T 3 and rT 3 levels increased significantly, but basal TSH levels and the TSH response to thyrotropin releasing hormone (TRH) decreased. Furthermore, after chemotherapy the increased T 4 and lowered TSH levels returned to normal, while the FT 3 level did not change either during or after chemotherapy [3], which suggested an unaltered hypothalamic / pituitary axis. Non-seminomatous germ-cell tumors (NSGCT) can comprise several different histological components, among which, choriocarcinoma, produces HCG.…”

“…The influence of chemotherapy on thyroid function was just seen as a late effect [1,2], mainly presenting hypothyroidism. Nevertheless, thyroid function decreasing does not occur in all cancer patients receiving chemotherapy, thyroxine (T 4 ), T 3 and reverse triiodothyronine (rT 3 ) levels of patients with non-seminoma testicular carcinoma increased significantly during chemotherapy [3], some choriocarcinoma patients even suffered thyroid crisis during chemotherapy [4,5], the cause may be the high levels of human chorionic gonadotrophin (HCG), producing biochemical and clinical hyperthyroidism [6]. While, non-seminoma testicular carcinoma and choriocarcinoma are rare human malignancies that are highly curable with chemotherapy or combination of surgery and chemotherapy, even with widespread metastases.…”

Neo-endocrinochemotherapy: A novel approach for enhancing chemotherapeutic efficacy in clinic?

“…The main cause for this phenomenon may be the usual presence of hCG in these patients. A research studied the effects of chemotherapy on thyroid function in patients with disseminated non-seminoma testicular tumors, T4, T3 and rT3 levels rose significantly during chemotherapy [7], which may relate with hCG exaggerated release as tumor was destroyed by chemotherapeutic drugs. So, from these clinical phenomena, it was inferred TH may have sensitization role in chemotherapy.…”

“…During chemotherapy, serum thyroxine (T4), T3 and rT3 levels increased significantly, but basal TSH levels and the TSH response to TRH decreased [7].…”

Disorders of the Endocrine System Due to Radiation and Cytotoxic Chemotherapy

“…Therefore combination chemotherapy (MVPP) alone did not appear to have any significant effect on thyroid function in our patients. Willemse et al (1982) studied thyroid function in men who received vinblastine, bleomycin and cis-diammine-dichloro-platinum (cis-DDP) for teratoma of the testis. They observed that the normalized serum thyroxine and rT3 levels rose significantly during chemotherapy, but the free T3 level remained unchanged.…”