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. 1999 May;80(5-6):808–814. doi: 10.1038/sj.bjc.6690425

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

E A Shafford 1, J E Kingston 1, J C Healy 2, J A W Webb 2, P N Plowman 3, R H Reznek 2
PMCID: PMC2362270  PMID: 10360659

Abstract

Patients 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. © 1999 Cancer Research Campaign

Keywords: childhood Hodgkin's, thyroid disease, neck irradiation

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Selected References

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  1. Carr R. F., LiVolsi V. A. Morphologic changes in the thyroid after irradiation for Hodgkin's and non-Hodgkin's lymphoma. Cancer. 1989 Aug 15;64(4):825–829. doi: 10.1002/1097-0142(19890815)64:4<825::aid-cncr2820640411>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  2. 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. Cancer. 1984 Feb 15;53(4):878–883. doi: 10.1002/1097-0142(19840215)53:4<878::aid-cncr2820530411>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  3. Crom D. B., Kaste S. C., Tubergen D. G., Greenwald C. A., Sharp G. B., Hudson M. M. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. Med Pediatr Oncol. 1997 Jan;28(1):15–21. doi: 10.1002/(sici)1096-911x(199701)28:1<15::aid-mpo4>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  4. DeGroot L. J., Kaplan E. L., McCormick M., Straus F. H. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990 Aug;71(2):414–424. doi: 10.1210/jcem-71-2-414. [DOI] [PubMed] [Google Scholar]
  5. Doniach I., Kingston J. E., Plowman P. N., Malpas J. S. The association of post-radiation thyroid nodular disease with compensated hypothyroidism. Br J Radiol. 1987 Dec;60(720):1223–1226. doi: 10.1259/0007-1285-60-720-1223. [DOI] [PubMed] [Google Scholar]
  6. Ezzat S., Sarti D. A., Cain D. R., Braunstein G. D. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994 Aug 22;154(16):1838–1840. doi: 10.1001/archinte.154.16.1838. [DOI] [PubMed] [Google Scholar]
  7. Fleming I. D., Black T. L., Thompson E. I., Pratt C., Rao B., Hustu O. Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer. Cancer. 1985 Mar 15;55(6):1190–1194. doi: 10.1002/1097-0142(19850315)55:6<1190::aid-cncr2820550609>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  8. Fogelfeld L., Wiviott M. B., Shore-Freedman E., Blend M., Bekerman C., Pinsky S., Schneider A. B. Recurrence of thyroid nodules after surgical removal in patients irradiated in childhood for benign conditions. N Engl J Med. 1989 Mar 30;320(13):835–840. doi: 10.1056/NEJM198903303201304. [DOI] [PubMed] [Google Scholar]
  9. Garcia C. J., Daneman A., McHugh K., Chan H., Daneman D. Sonography in thyroid carcinoma in children. Br J Radiol. 1992 Nov;65(779):977–982. doi: 10.1259/0007-1285-65-779-977. [DOI] [PubMed] [Google Scholar]
  10. Gharib H., Goellner J. R. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993 Feb 15;118(4):282–289. doi: 10.7326/0003-4819-118-4-199302150-00007. [DOI] [PubMed] [Google Scholar]
  11. Green D. M., Brecher M. L., Yakar D., Blumenson L. E., Lindsay A. N., Voorhess M. L., MacGillivray M., Freeman A. I. Thyroid function in pediatric patients after neck irradiation for Hodgkin disease. Med Pediatr Oncol. 1980;8(2):127–136. doi: 10.1002/mpo.2950080205. [DOI] [PubMed] [Google Scholar]
  12. Hancock S. L., Cox R. S., McDougall I. R. Thyroid diseases after treatment of Hodgkin's disease. N Engl J Med. 1991 Aug 29;325(9):599–605. doi: 10.1056/NEJM199108293250902. [DOI] [PubMed] [Google Scholar]
  13. Healy J. C., Shafford E. A., Reznek R. H., Webb J. A., Thomas J. M., Bomanji J. B., Kingston J. E. Sonographic abnormalities of the thyroid gland following radiotherapy in survivors of childhood Hodgkin's disease. Br J Radiol. 1996 Jul;69(823):617–623. doi: 10.1259/0007-1285-69-823-617. [DOI] [PubMed] [Google Scholar]
  14. Kaplan M. M., Garnick M. B., Gelber R., Li F. P., Cassady J. R., Sallan S. E., Fine W. E., Sack M. J. Risk factors for thyroid abnormalities after neck irradiation for childhood cancer. Am J Med. 1983 Feb;74(2):272–280. doi: 10.1016/0002-9343(83)90626-5. [DOI] [PubMed] [Google Scholar]
  15. Peerboom P. F., Hassink E. A., Melkert R., DeWit L., Nooijen W. J., Bruning P. F. Thyroid function 10-18 years after mantle field irradiation for Hodgkin's disease. Eur J Cancer. 1992;28A(10):1716–1718. doi: 10.1016/0959-8049(92)90075-d. [DOI] [PubMed] [Google Scholar]
  16. Soberman N., Leonidas J. C., Cherrick I., Schiff R., Karayalcin G. Sonographic abnormalities of the thyroid gland in longterm survivors of Hodgkin disease. Pediatr Radiol. 1991;21(4):250–253. doi: 10.1007/BF02018615. [DOI] [PubMed] [Google Scholar]
  17. Stewart R. R., David C. L., Eftekhari F., Ried H. L., Fuller L. M., Fornage B. D. Thyroid gland: US in patients with Hodgkin disease treated with radiation therapy in childhood. Radiology. 1989 Jul;172(1):159–163. doi: 10.1148/radiology.172.1.2662250. [DOI] [PubMed] [Google Scholar]
  18. Tan G. H., Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997 Feb 1;126(3):226–231. doi: 10.7326/0003-4819-126-3-199702010-00009. [DOI] [PubMed] [Google Scholar]

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