skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Thyroid dysfunction after radiotherapy in children with Hodgkin's disease

Abstract

Thyroid function was measured in 119 children, 16 years of age or less, after radiotherapy (XRT) for Hodgkin's disease. Thyroid abnormalities developed in 4 of 24 children (17%) who received 2600 rad or less, and in 74 of 95 children (78%) who received greater than 2600 rad to the cervical area, including the thyroid. The abnormality in all but three (one with hyperthyroidism and two with thyroid nodules) included the development of elevated levels of thyroid stimulating hormone (TSH). Age, sex, and administration of chemotherapy were not significant factors in the development of thyroid dysfunction. All children had lymphangiograms (LAG) and no time relationship was noted between thyroid dysfunction and LAG-XRT interval. The mean interval from radiotherapy to documented thyroid dysfunction was 18 months in the low-dose group and 31 months in the high-dose group, with most patients becoming abnormal within 3 to 5 years. Of interest was a spontaneous return of TSH to within normal limits in 20 children and substantial improvement in another 7. This study confirms the occurrence of dose-related occult hypothyroidism in children following external irradiation of the neck.

Authors:
; ; ; ; ;
Publication Date:
Research Org.:
Stanford Univ. Medical Center, CA
OSTI Identifier:
6407914
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cancer (Philadelphia); (United States); Journal Volume: 53:4
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 62 RADIOLOGY AND NUCLEAR MEDICINE; HODGKINS DISEASE; RADIOTHERAPY; SIDE EFFECTS; THYROID; BIOLOGICAL RADIATION EFFECTS; CHILDREN; DOSE-RESPONSE RELATIONSHIPS; HYPOTHYROIDISM; AGE GROUPS; BIOLOGICAL EFFECTS; BODY; DISEASES; ENDOCRINE DISEASES; ENDOCRINE GLANDS; GLANDS; LYMPHOMAS; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; RADIATION EFFECTS; RADIOLOGY; THERAPY; 560151* - Radiation Effects on Animals- Man; 550603 - Medicine- External Radiation in Therapy- (1980-)

Citation Formats

Constine, L.S., Donaldson, S.S., McDougall, I.R., Cox, R.S., Link, M.P., and Kaplan, H.S.. Thyroid dysfunction after radiotherapy in children with Hodgkin's disease. United States: N. p., 1984. Web. doi:10.1002/1097-0142(19840215)53:4<878::AID-CNCR2820530411>3.0.CO;2-J.
Constine, L.S., Donaldson, S.S., McDougall, I.R., Cox, R.S., Link, M.P., & Kaplan, H.S.. Thyroid dysfunction after radiotherapy in children with Hodgkin's disease. United States. doi:10.1002/1097-0142(19840215)53:4<878::AID-CNCR2820530411>3.0.CO;2-J.
Constine, L.S., Donaldson, S.S., McDougall, I.R., Cox, R.S., Link, M.P., and Kaplan, H.S.. 1984. "Thyroid dysfunction after radiotherapy in children with Hodgkin's disease". United States. doi:10.1002/1097-0142(19840215)53:4<878::AID-CNCR2820530411>3.0.CO;2-J.
@article{osti_6407914,
title = {Thyroid dysfunction after radiotherapy in children with Hodgkin's disease},
author = {Constine, L.S. and Donaldson, S.S. and McDougall, I.R. and Cox, R.S. and Link, M.P. and Kaplan, H.S.},
abstractNote = {Thyroid function was measured in 119 children, 16 years of age or less, after radiotherapy (XRT) for Hodgkin's disease. Thyroid abnormalities developed in 4 of 24 children (17%) who received 2600 rad or less, and in 74 of 95 children (78%) who received greater than 2600 rad to the cervical area, including the thyroid. The abnormality in all but three (one with hyperthyroidism and two with thyroid nodules) included the development of elevated levels of thyroid stimulating hormone (TSH). Age, sex, and administration of chemotherapy were not significant factors in the development of thyroid dysfunction. All children had lymphangiograms (LAG) and no time relationship was noted between thyroid dysfunction and LAG-XRT interval. The mean interval from radiotherapy to documented thyroid dysfunction was 18 months in the low-dose group and 31 months in the high-dose group, with most patients becoming abnormal within 3 to 5 years. Of interest was a spontaneous return of TSH to within normal limits in 20 children and substantial improvement in another 7. This study confirms the occurrence of dose-related occult hypothyroidism in children following external irradiation of the neck.},
doi = {10.1002/1097-0142(19840215)53:4<878::AID-CNCR2820530411>3.0.CO;2-J},
journal = {Cancer (Philadelphia); (United States)},
number = ,
volume = 53:4,
place = {United States},
year = 1984,
month = 2
}
  • The thyroid gland is commonly included in the field of radiation therapy for patients with malignant lymphoma and with head and neck tumors. The radiation dose for malignant diseases varies considerably depending on the purpose of treatment and the institutional policies. A substantial number of these patients are developing subclinical and clinical hypothyroidism. The risk of developing hypothyroidism after a moderate radiation dose of 2000 to 4500 rads has been reported to be 10 to 20 percent. In addition, subclinical hypothyroidism is induced further in one third of the patients. There are also suggestions that external irradiation of the thyroidmore » gland in patients with malignant lymphomas, as well as internal irradiation with radioiodine of the normal and hyperthyroid human thyroid glands, would induce elevations of serum antithyroid autoantibody titers. However, only a few cases of Graves disease following irradiation to the thyroid gland have been reported. We encountered a young woman who received radiation therapy to the mantle field for her Hodgkin's disease and developed hypothyroxinemia without overt signs and symptoms of hypothyroidism, followed by appearance of nodular goiter and then full-blown Graves disease.« less
  • Thyroid-stimulating hormone (TSH) and thyroxine (T/sub 4/) were measured in sera from 214 patients with Hodgkin's disease. The literature was reviewed for patients with lymphoma or head and neck carcinoma who had received prior radiation therapy that encompassed the thyroid. Among 169 patients who had been treated with mantle radiation therapy at our center, 112 (66%) had evidence of thyroid dysfunction, including 43 with depressed T/sub 4/ levels. Among 45 who did not receive mantle irradiation, only three had evidence of dysfunction and none of these had T/sub 4/ depression. Thyroid dysfunction developed slowly, with less than 15% of patientsmore » tested during the first year showing dysfunction and the maximum of 66% reached at about 6 years. This entity is very common in lymphoma patients yet often is overlooked except in instances of specific thyroid function evaluation for research. A substantial proportion of patients with head and neck carcinoma develops thyroid dysfunction after irradiation, especially if therapy includes hemithyroidectomy. Serum TSH measurement every 6 months for at least 5 to 6 years after irradiation will detect early thyroid dysfunction. All patients with elevated serum TSH should be treated with sodium levothyroxine, regardless of whether they are clinically hypothyroid.« less
  • A rapidly fatal T-cell lymphoma developed in a 25-year-old man who, over a period of seven years, had been treated with radiotherapy and combination chemotherapy for Hodgkin's disease (HD). Non-Hodgkin's lymphoma (NHL) is increasingly being recognized as a late sequel of therapy for HD, but this is the first case in which NHL of T-cell type has been identified in such circumstances.
  • We studied the clinical and pathological features of six cases of non-Hodgkin's lymphoma occuring in patients treated for Hodgkin's disease. All six patients had received both radiation therapy and chemotherapy. Abdominal or gastrointestinal involvement was present in five of the six cases. None of the patients had evidence of Hodgkin's disease when the diagnosis of non-Hodgkin's lymphoma was made. Five of the six patients were among a study group of 579 patients with Hodgkin's disease, prospectively followed since diagnosis. At 10 years the actuarial risk of development of non-Hodgkin's lymphoma in this study group is 4.4 per cent and ismore » similar to that of developing acute leukemia: 2.0 per cent. Non-Hodgkin's lymphoma is a second tumor that may occur late in the course of patients treated for Hodgkin's disease, particularly in patients who have received both radiation therapy and chemotherapy. Like acute leukemia, non-Hodgkin's lymphoma may be another cancer that represents a substantial late risk of combined-modality therapy.« less
  • Improved survival resulting from advances in therapy in patients with Hodgkin's disease is associated with long-term morbidity, including the potential for the development of a second solid malignancy. We report a 44-year-old man with an unusually aggressive course of thyroid carcinoma 15 years after treatment for Hodgkin's disease. In a review of the English-language literature, we found 21 cases of thyroid cancer following radiotherapy for Hodgkin's disease, with latency periods ranging from 6 to 48 years. The development of secondary thyroid cancer after high-dose neck irradiation may be related to hypothyroidism, itself a complication of radiotherapy. Thyroid function should bemore » measured at least once a year in all patients given neck irradiation, with initiation of thyroid hormone replacement if there is evidence of sustained hypothyroidism.« less