Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer

Fleming, Irvin D.; Black, Timothy L.; Thompson, Elizabeth I.; Pratt, Charles B.; Rao, Bhaskar N.; Hustu, Omar

doi:10.1002/1097-0142(19850315)55:6<1190::aid-cncr2820550609>3.0.co;2-6

Cited by 74 publications

(23 citation statements)

References 24 publications

(1 reference statement)

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“…This is in agreement with the findings of Fleming et al (1985). However, some studies have shown an increase in thyroid dysfunction associated with lymphangiography (Kaplan et al, 1983), whereas others have shown a protective effect (Green et al, 1980).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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SummaryPatients who receive radiotherapy to the neck are at risk of developing thyroid dysfunction. This prospective study of patients whose treatment for Hodgkin's disease in childhood included radiotherapy to the neck aimed to investigate the incidence and natural history of thyroid dysfunction and the morphological changes of the gland demonstrated on ultrasound. Forty-seven patients were investigated by clinical examination, thyroid function tests and thyroid ultrasound. Only six patients had a clinically detectable abnormality, but 64% had abnormal thyroid function tests. All patients had an abnormal thyroid ultrasound scan and 42% had at least one focal abnormality. A significant association was found between the presence of a focal lesion on ultrasound and young age at radiotherapy, longer follow-up and the length of time that the thyroid-stimulating hormone (TSH) level had been elevated. During follow-up, 65% of patients not on thyroxine developed new focal abnormalities. The longest time interval between radiotherapy and an increase in TSH level was 94 months, and from radiotherapy to the appearance of a focal abnormality on thyroid ultrasound was over 18 years. Three patients were found to have a thyroid carcinoma. These findings indicate the importance of long-term follow-up for patients treated by neck irradiation for Hodgkin's disease in childhood.

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Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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“…Irradiation of the thyroid gland has been associated with development of compensated hypothyroidism, overt hypothyroidism, thyroiditis and thyroid neoplasms. 1 After irradiation the onset of thyroid dysfunction often begins as compensated hypothyroidism with elevated thyroid-stimulating hormone (TSH) and normal thyroid hormone production, but then may progress to overt hypothyroidism over the next several decades. Hypothyroidism contributes to decreased height growth in children.…”

Section: Thyroid Functionmentioning

confidence: 99%

Growth and development after hematopoietic cell transplant in children

Sanders

2007

Bone Marrow Transplant

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Hematopoietic cell transplantation (HCT) following high-dose chemotherapy or chemoradiotherapy for children with malignant or nonmalignant hematologic disorders has resulted in an increasing number of long-term diseasefree survivors. The preparative regimens include high doses of alkylating agents, such as CY with or without BU, and may include TBI. These agents impact the neuroendocrine system in growing children and their subsequent growth and development. Children receiving high-dose CY or BUCY have normal thyroid function, but those who receive TBI-containing regimens may develop thyroid function abnormalities. Growth is not impacted by chemotherapy-only preparative regimens, but TBI is likely to result in growth hormone deficiency and decreased growth rates that need to be treated with synthetic growth hormone therapy. Children who receive high-dose CY-only have normal development through puberty, whereas those who receive BUCY have a high incidence of delayed pubertal development. Following fractionated TBI preparative regimens, approximately half of the patients have normal pubertal development. These data demonstrate that the growth and development problems after HCT are dependent upon the preparative regimen received. All children should be followed for years after HCT for detection of growth and development abnormalities that are treatable with appropriate hormone therapy.

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“…Studies on patients receiving irradiation treatment for various cancers have reported a high frequency of benign and malignant thyroid nodules. The reported relative risks for thyroid nodules among the survivors of pediatric cancers who have undergone radiation therapy vary greatly, with an incidence of malignancy of 10-40% (6,7,8,9,10,11,12,13). Analysis of studies evaluating thyroid carcinoma after exposure to external radiation during childhood showed that the dose-response relationship was linear, although the risk appeared to plateau at the highest dose, with risk appearing to slightly decrease at doses of even more than 2000 cGy (9,11,13,14,15,16).…”

Section: Introductionmentioning

confidence: 99%

Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood

Vivanco

Dalle²,

Alberti³

et al. 2012

European Journal of Endocrinology

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Background: The risk of radiation-induced benign and malignant thyroid nodules is well known. Objective: The aim of this study was to determine the occurrence of thyroid nodules and carcinomas after fractionated total body irradiation (TBI) preceding hematopoietic stem cell transplantation (HSCT) for malignant hematological disease during childhood. Methods: We conducted a retrospective university hospital-based observational study. The participants were 76 patients receiving fractionated TBI between 1989 and 2009 as part of the conditioning regimen for HSCT to treat malignant hematological disease, with a median age of 8.2 (5.7-11.4) years, for whom the last ultrasound examination was performed at a median age of 14.2 (11.2-17) years. The main outcome measure was cumulative incidence of thyroid nodules detected by ultrasound scans followed by biopsy if necessary. Results: Thyroid nodules were examined in 21 (28%) patients, six (29%) of whom were diagnosed with thyroid carcinoma at the age of 2.2-18.6 years after TBI. The cumulative incidence of nodule occurrence increased with increasing time from diagnosis. The 10-year cumulative incidence of benign and malignant thyroid nodules was 16% (95% confidence interval (CI) 4-27%) and 8% (95% CI 0-16%) respectively. Seventeen (22%) patients had hypothyroidism (compensated nZ12, in five patients it was transient). No significant independent risk factors were identified in the multivariable competing risk model as a function of nodule occurrence. Conclusion: Short-term and life-long monitoring, with screening for nodules of the thyroid gland using ultrasound scans, is recommended for survivors subjected to TBI for HSCT during childhood.

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Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer

Cited by 74 publications

References 24 publications

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

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

Growth and development after hematopoietic cell transplant in children

Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood

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