Myxodema After Deep X-ray Therapy to the Neck

Markson, J. L.; Flatman, G. E.

doi:10.1136/bmj.1.5444.1228

Cited by 68 publications

(15 citation statements)

References 9 publications

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“…Although the thyroid gland is not usually the radiation target, exposure of the thyroid to radiation during radiotherapy of the head and neck is often unavoidable. Hypothyroidism after radiotherapy for head and neck cancer was first reported in the 1960s [1] . Since then, many publications have described radiotherapy-induced thyroid disorders such as hypothyroidism, thyroiditis, Graves' disease, adenoma, and carcinoma [2] – [4] .…”

Section: Introductionmentioning

confidence: 99%

Alpha Lipoic Acid Attenuates Radiation-Induced Thyroid Injury in Rats

Jung

Kim

et al. 2014

PLoS ONE

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Exposure of the thyroid to radiation during radiotherapy of the head and neck is often unavoidable. The present study aimed to investigate the protective effect of α-lipoic acid (ALA) on radiation-induced thyroid injury in rats. Rats were randomly assigned to four groups: healthy controls (CTL), irradiated (RT), received ALA before irradiation (ALA + RT), and received ALA only (ALA, 100 mg/kg, i.p.). ALA was treated at 24 h and 30 minutes prior to irradiation. The neck area including the thyroid gland was evenly irradiated with 2 Gy per minute (total dose of 18 Gy) using a photon 6-MV linear accelerator. Greater numbers of abnormal and unusually small follicles in the irradiated thyroid tissues were observed compared to the controls and the ALA group on days 4 and 7 after irradiation. However, all pathologies were decreased by ALA pretreatment. The quantity of small follicles in the irradiated rats was greater on day 7 than day 4 after irradiation. However, in the ALA-treated irradiated rats, the numbers of small and medium follicles were significantly decreased to a similar degree as in the control and ALA-only groups. The PAS-positive density of the colloid in RT group was decreased significantly compared with all other groups and reversed by ALA pretreatment. The high activity index in the irradiated rats was lowered by ALA treatment. TGF-ß1 immunoreactivity was enhanced in irradiated rats and was more severe on the day 7 after radiation exposure than on day 4. Expression of TGF-ß1 was reduced in the thyroid that had undergone ALA pretreatment. Levels of serum pro-inflammatory cytokines (TNF-α, IL-1ß and IL-6) did not differ significantly between the all groups. This study provides that pretreatment with ALA decreased the severity of radiation-induced thyroid injury by reducing inflammation and fibrotic infiltration and lowering the activity index. Thus, ALA could be used to ameliorate radiation-induced thyroid injury.

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Section: Introductionmentioning

confidence: 99%

Alpha Lipoic Acid Attenuates Radiation-Induced Thyroid Injury in Rats

Jung

Kim

et al. 2014

PLoS ONE

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“…Although some of these patients did develop slightly elevated levels of anti-microsomal and antithyroglobulin antibodies following irradiation, it was felt that the hypothyroidism could not be attributed to an autoimmune mechanism. However, Markson and Flatman have reported 5 patients who became hypothyroid 4 to 12 months following neck X-irradiation for nonthyroidal malignancies (20). Each of their patients developed serum anti-thyroid antibodies.…”

Section: Discussionmentioning

confidence: 99%

Graves' Ophthalmopathy Following External Neck Irradiation for Nonthyroidal Neoplastic Disease

Wasnich

Grumet

Payne

et al. 1973

The Journal of Clinical Endocrinology & Metabolism

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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Abstract. A case of hypothyroid Graves' disease occurred following external radiation therapy to the cervical region is described. Severe hypothyroidism developed in a 56-year-old man 6 months after external radiation therapy for submandibular cancer. Serological evaluation of thyroid autoimmunity revealed the presence of antithyroid antibodies and thyrotropin-binding inhibitory immunogloblins (TBII). Diplopia, limitation of downward gaze, and palpebral edema developed 2 years after levothyroxine replacement therapy. Ocular magnetic resonance imaging revealed marked hypertrophy of the bilateral extraocular muscles with signal hyperintensity on T2-weighted images. This infiltrative ophthalmopathy showed marked improvement after additional treatment with high-dose methylprednisolone and orbital radiation, in parallel with a decrease in TBII. These results suggest that radiation-associated thyroidal injury might be associated with the etiology of hypothyroid Graves' disease.

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Myxodema After Deep X-ray Therapy to the Neck

Cited by 68 publications

References 9 publications

Alpha Lipoic Acid Attenuates Radiation-Induced Thyroid Injury in Rats

Alpha Lipoic Acid Attenuates Radiation-Induced Thyroid Injury in Rats

Graves' Ophthalmopathy Following External Neck Irradiation for Nonthyroidal Neoplastic Disease

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

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