Sonographic abnormalities of the thyroid gland in longterm survivors of Hodgkin disease

Abstract

We studied the thyroid gland in 18 long term survivors of Hodgkin Disease, all of whom received radiation therapy (2400-4000 cGy, mean 3434). Evaluation included clinical examination, thyroid function tests, ultrasound, as well as selective use of nuclear scintigraphy. The time interval post radiation was 1-16 years (mean 6.4 years). Clinical evaluation and thyroid function tests were insensitive in detecting abnormalities and most nodules were non palpable. Ultrasound detected abnormalities in 16 patients (89%) including diffuse atrophy (n = 6), solitary nodules (n = 4), multiple nodules (n = 5) and gland heterogeneity with calcification in one patient. Cold nodules on nuclear scintigraphy (n = 4) were subjected to biopsy. Multiple foci of papillary carcinoma were found in one patient. There was a tendency for nodules to increase in number as the post radiation interval also increased. We recommend frequent sonographic evaluation and early suppression of thyroid stimulation in an attempt to arrest the development of neoplastic changes.

Thyroid nodular disease after radiotherapy to the neck for childhood Hodgkin’s disease

“…This study confirms the diversity of thyroid disease which may affect patients whose treatment for Hodgkin's disease in childhood included radiotherapy to the neck (Green et al, 1980;Kaplan et al, 1983;Constantine et al, 1984;Stewart et al, 1989;Hancock et al, 1991;Soberman et al, 1991;Peerboom et al, 1992). It also emphasizes the need for continuing follow-up of this group of patients.…”

“…This study confirms the insensitivity of thyroid palpation in detecting thyroid nodules (Soberman et al, 1991;Crom et al, 1997). Although thyroid ultrasound scans have been performed prospectively many of our patients had been off treatment for more than 10 years before the first scan was done so it is not possible to say when the abnormality first appeared.…”

“…They are also more likely to develop both benign and malignant nodules of the thyroid gland (Stewart et al, 1989;Soberman et al, 1991). In 1991, we started a prospective study of the thyroid gland in patients whose treatment for Hodgkin's disease in childhood had included radiotherapy to the neck.…”

Decreased thyroid peroxidase expression in cultured thyrocytes after external gamma irradiation

“…Thyroid glands obtained from these patients at autopsy frequently show striking histological changes such as multinodularity, multiple adenomas, extensive lymphoid infiltration and interstitial fibrosis as well as a higher incidence of malignancy (Hanson et al, 1983;Black et al, 1998). Ultrasonography and radionuclid scintigraphy of the thyroid gland also revealed abnormalities of the thyroid structure in long-term survivors of childhood cancer who received radiation therapy of the head and/or neck (Soberman et al, 1991;Crom et al, 1997). Although late irradiation effects are well documented, little is still known about early functional alterations in thyroid cells subjected to radiation therapy.…”

The Shrinking Thyroid: How Does Thyroid Size Change Following Radiation Therapy for Laryngeal Cancer?

“…Morphologic changes to the thyroid gland after XRT, such as the development of solid or cystic masses, are well documented by sonography and histology. [13][14][15][16][17][18] The thyroid gland is known to decrease in the size after XRT as demonstrated by sonography. 18 Patients with laryngeal cancer are followed after treatment with CT of the neck to evaluate treatment response and monitor for recurrence; however, radiologists rarely mention changes in the size of the thyroid gland on follow-up CT reports following XRT for head and neck cancer.…”