Thyroid function in pediatric patients after neck irradiation for Hodgkin disease

Abstract

Thyroid function was evaluated in a consecutively treated group of children and adolescents with Hodgkin disease who received incidental radiation to the thyroid gland. Ten of 27 (36.7%) were found to have elevated concentrations of thyroid-stimulating hormone (TSH). Two groups of patients had an increased incidence of thyroid dysfunction - those who had not had a pretreatment lymphangiogram and those who were less than 13 years of age at the time of neck irradiation. The estimated percentage of patients who did not have a pretreatment lymphangiogram who will develop TSH elevation was 67.7% and of patients who were 13 years of age or less when irradiated, 64.8%. Thyroid dysfunction developed in 6/7 patients who had both of these risk factors present.

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

“…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). Neither did we demonstrate any relationship between lymphangiography and focal abnormalities in the thyroid gland.…”

“…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.…”

“…In this study the longest documented time interval from radiotherapy to an elevated TSH level was 7 years 10 months but other studies have noted an even longer time interval, of up to 18 years (Hancock et al, 1991). Fifty-seven per cent of patients developed subclinical hypothyroidism and an additional two patients (4%) also had low serum thyroxine levels These results are comparable to those reported by Peerboom et al (1992) but others have noted a considerable variation in the frequency of subclinical hypothyroidism (36-63%) (Green et al, 1980;Constantine et al, 1984).…”

“…Patients who receive radiotherapy to the neck are at increased risk of developing thyroid dysfunction -usually biochemical hypothyroidism, but occasionally clinical hypothyroidism or thyrotoxicosis (Green et al, 1980;Kaplan et al, 1983;Constantine et al, 1984;Hancock et al, 1991;Peerboom et al, 1992). They are also more likely to develop both benign and malignant nodules of the thyroid gland (Stewart et al, 1989;Soberman et al, 1991).…”

Hypothyroidism and Thyroiditis after Therapy for Hodgkin’s Disease

“…We diagnosed hypothyroidism in a quarter of our HD patients, in one third of patients receiving neck or mantle RT and almost in half of the patients at least 6 years after the treatment [7, 8, 9]. No differences were found in the histological subtypes, disease stage, age at the diagnosis of HD between the groups of patients with normal and decreased thyroid function [9, 11, 12], though Green et al [29] claim that the thyroid is more sensitive to RT in children than in adults. In accordance with data in the literature [9, 11], hypothyroidism was found 1.5 times more frequently in women than in men, which indicates that in HD patients the pathomechanism of the disease may be different than that of primary hypothyroidism, since the latter is 7–8 times more frequent in women and in most cases chronic autoimmune thyroiditis is found in the background.…”