Hypothyroidism and Thyroiditis after Therapy for Hodgkin’s Disease

Abstract

During the follow-up of thyroid function of 151 patients with Hodgkin’s disease in complete remission for at least 1 year, 26 cases of subclinical, 12 cases of manifest clinical hypothyroidism and 2 cases of hyperthyroidism (Graves-Basedow disease) were confirmed. Thyroid dysfunction was more frequent in patients who had undergone mantle or neck radiotherapy. Hypothyroidism was most often revealed from the 6th year on following radiotherapy. Thyroid autoantibody positivity was found to be more frequent in patients with thyroid dysfunction, and conversely, thyroid dysfunction was more frequent among the 28 patients with autoantibody positivity. Ultrasound examination and fine needle aspiration cytology of the thyroid confirmed thyroiditis in 96% of the patients with antibody positivity. No relationship was found between thyroiditis and the form of treatment for Hodgkin’s disease. We have found that both neck irradiation and thyroiditis may play a role in the increased number of thyroid dysfunction in patients treated for Hodgkin’s disease. Thyroiditis is not caused by neck radiotherapy but may be the result of immune regulation disorders in Hodgkin’s disease. For substitution or isohormone therapy, levothyroxine is suggested for use. We suggest that examination of the thyroid should be performed at least once a year during the follow-up of Hodgkin’s disease patients.

Is the Treatment of Hodgkin’s Disease Detrimental to the Parathyroid Gland?

“…With long-term survival or recovery of the patients, late complications of the treatment influencing the quality of life and survival rate have become manifest [3, 4, 5, 6]. Our previous studies confirmed that treatment of HD often resulted in the injury of the thyroid gland, and subclinical or clinical hypothyroidism or thyroiditis developed, mostly in patients receiving neck irradiation [6]. …”

Thyrotoxicosis after severe hypothyroidism in a patient with a history of Hodgkin's lymphoma and neck irradiation

“…The aetiology of radiation-induced thyroid dysfunction includes vascular damage, parenchymal cell damage and autoimmune reactions [1]. According to some authors, thyroiditis observed in Hodgkin's disease may be the result of immune regulation disorders in Hodgkin's disease [2]. Our case illustrates that after neck irradiation, severe hypothyroidism can be followed by thyrotoxicosis.…”

A Case of Hypothyroid Graves' Disease Following External Radiation Therapy to the Cervical Region

“…Furthermore, all patients had Hodgkin's or nonHodgkin's lymphoma. Thyroid dysfunction observed in malignant lymphoma survivors can be caused in part by immune regulation disorders [6], suggesting that thyroid dysfunction might occur even if these patients did not receive cervical radiation therapy.…”

“…A possible mechanism of radiotherapy-induced thyroid dysfunction involves direct thyroid cell injury from radiation and immunological reactions induced by the release of autoantigens or by T helper lymphocyte overbalance [1,2]. The frequency of autoimmune thyroid diseases, including Hashimoto's thyroiditis [16,17], Graves' disease [3][4][5][6] and Graves' ophthalmopathy [4], in patients who have received external radiation therapy is significantly higher than that in untreated controls. Indeed, patients who have received external radiation to the cervical region are more likely to have antithyroid antibodies than are untreated patients [17], and the titers of antithyroid antibodies are elevated after radiation therapy [18].…”

“…The risk of thyroid cancer in these patients is 15 times as high as that in a nonirradiated population [1,2]. In addition, Graves' disease, Graves' ophthalmopathy or both may develop after external radiation therapy, with a prevalence of 0.1% to 7%, in patients treated for Hodgkin's disease [3][4][5][6].…”