Post-Treatment Thyroid Diseases in Children with Brain Tumors: A Single-Center Experience at “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca

Abstract

Aim of study: The purpose of the study was to evaluate the association of thyroid dysfunction occurring in pediatric patients treated for brain tumors. Patients and methods: A total of 255 patients with brain tumors were treated between 2001 and 2018 at the “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca. Due to a minimum follow-up of 4 years, we studied 184 out of the 255 patients. The cohort included 69 girls (37.5%) and 109 boys (62.5%), with a median age of 8.4 years. The evaluated tumors included medulloblastomas (47 patients), astrocytomas (44 patients), ependymomas (22 patients), gliomas (20 patients), germ cell tumors (12 patients), primitive neuroectodermal tumors (4 patients), as well as other types of tumors (15 patients); in 20 of the cases, biopsy could not be performed. Results: There was a 60% overall survival rate; among the 120 surviving patients, 11 (9.1%) were diagnosed with iatrogenic thyroid disease. We observed an important number of iatrogenic thyroid disease cases in this group of patients, thus revealing the importance of long-term thyroid function evaluation in all children who finalized their treatment for brain tumors. Through this study, we aimed to provide an accurate image of the methodology of monitoring for thyroid dysfunction in childhood brain tumor survivors. Conclusion: Given the fact that the probability of developing thyroid dysfunction in the pediatric population treated for brain tumors is not rare, we recommend that childhood brain tumor survivors be monitored for iatrogenic thyroid disease, in order to provide early diagnosis and treatment.

Homeostatic status of thyroid hormones and brain water movement as determinant factors in biology of cerebral gliomas: a pilot study using a bioinformatics approach

“…In pediatric patients, an important probability of developing thyroid dysfunction was found post-treatment with surgery, chemotherapy, and radiotherapy ( Jin et al, 2018 ; Cosnarovici et al, 2020 ); moreover, abnormalities in thyroid function were found in patients with AQP4 antibody–seropositive optic neuritis ( Zhao et al, 2017 ).…”

“…In pediatric patients, an important probability of developing thyroid dysfunction was found post-treatment with surgery, chemotherapy, and radiotherapy (Jin et al, 2018;Cosnarovici et al, 2020); moreover, abnormalities in thyroid function were found in patients with AQP4 antibody-seropositive optic neuritis (Zhao et al, 2017). We previously identified a negative modulator of AQP4 protein and demonstrated that triiodothyronine (T3) treatment of GBM-95-line cells resulted in a slight reduction in cell migration (Costa et al, 2019); other studies have also evaluated the modulatory action of this hormone on the expression of AQP4 in stroke animal models (Sadana et al, 2015).…”

Thyroid Hormone Suppresses Medulloblastoma Progression Through Promoting Terminal Differentiation of Tumor Cells

“…Hypothyroidism is a prevalent endocrine disorder in patients with MB, primarily considered a consequence of aggressive tumor treatments, particularly craniospinal irradiation 15,16 . However, the potential impact of hypothyroidism on MB progression has remained unexplored.…”

“…In the brain, thyroid receptor α1 (TRα1) predominates and serves as a transcription factor for regulating the transcription of TH target genes, including Krueppel-like factor 9 ( Klf9 ) and hairless ( Hr ) 14 . Patients with MB commonly exhibit hypothyroidism (reduced plasma levels of TH), which is classically considered a treatment-related complication 15,16 . A possible role of TH, or hypothyroidism, in MB pathogenicity has never been investigated.…”