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Acute effects on the thyroid gland after non-directed radiation therapy in children and adolescents

Published online by Cambridge University Press:  12 June 2013

C. C. Bonato ,
H. B. Dias ,
M. da S. Alves ,
L. O. Duarte ,
T. M. Dias ,
M. O. Dalenogare ,
C. C. B. Viegas  and
R. H. Elnecave
C. C. Bonato
Affiliation:
Graduate Program in Internal Medicine, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
H. B. Dias
Affiliation:
Graduate Program in Internal Medicine, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
M. da S. Alves
Affiliation:
Radiation Therapy Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
L. O. Duarte
Affiliation:
Radiation Therapy Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
T. M. Dias
Affiliation:
Radiation Therapy Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
M. O. Dalenogare
Affiliation:
Radiation Therapy Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
C. C. B. Viegas
Affiliation:
Ionizing Radiation Quality Program, Brazilian National Cancer Institute (INCA), José de Alencar Gomes da Silva, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
R. H. Elnecave*
Affiliation:
Graduate Program in Internal Medicine, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
*
Correspondence to: Regina Helena Elnecave, Endocrinology Service, HCPA, Rua Ramiro Barcelos, 2350/12, 4° andar, CEP 90035003 Porto Alegre, RS, Brazil. Tel/Fax: +55 51 33598127. E-mail: rhelnecave@gmail.com
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Abstract

Background

During radiation therapy, unwanted scatter to healthy tissues outside the target field may occur. Children and adolescents are more sensitive to radiation injury, and the thyroid gland is particularly susceptible to these effects.

Purpose

To assess acute changes in thyroid function and volume in children and adolescents undergoing radiotherapy for a variety of non-thyroid cancers.

Materials and Methods

Thirty-one children and adolescents underwent radiation therapy of various body areas in which the thyroid was not included. Thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), anti-thyroperoxidase antibodies and thyroglobulin were measured before, on the last day and at 1 and 3 months after the end of radiotherapy. Ultrasound scans were taken and 6- and 24-hour 131I uptake was measured before and after treatment. The scattered dose to the thyroid region was estimated with a treatment planning system or measured with thermoluminescent dosimeters.

Results

The median radiation dose scattered to the thyroid was 296·6 cGy (IQR 16·7–1,709·0). Levels of TSH (p = 0·575), T4 (p = 0·950), fT4 (p = 0·510), T3 (p = 0·842), thyroglobulin (p = 0·620) and anti-thyroid peroxidase antibodies (p = 0·546) were statistically similar at all four time points. There were no differences between pre- and post-radiotherapy thyroid volume and 131I uptake (p = 0·692 and 0·92, respectively).

Conclusion

More sensitive methods may be required to ascertain whether acute injury to the follicular epithelium occurs with lower radiation doses scattered to the thyroid.

Keywords

acute effectsadolescentchildradiotherapythyroid gland
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 3 , September 2014 , pp. 310 - 316
Copyright
Copyright © Cambridge University Press 2013 

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References

1.St. Jude Children's Research Hospital. Long-term follow up study; 2012. http://www.cancer.umn.edu/page/ltfu/p_csurv.html. Accessed on 27th September 2012.Google Scholar
2.Horner, M J, Ries, L A G, Krapcho, M et al. SEER Cancer Statistics Review, 1975–2006. Bethesda, MD: National Cancer Institute; 2009. http://seer.cancer.gov/csr/1975_2006/. Accessed on 27th September 2012.Google Scholar
3.Armstrong, G T, Stovall, M, Robison, L L. Long-term effects of radiation exposure among adult survivors of childhood cancer: results from the childhood cancer survivor study. Radiat Res 2010; 174: 840–850.Google Scholar
4.Taylor, M L, Kron, T, Franich, R D. Assessment of out-of-field doses in radiotherapy of brain lesions in children. Int J Radiat Oncol Biol Phys 2011; 79: 927–933.Google Scholar
5.Ron, E, Lubin, J H, Shore, R Eet al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 1995; 141: 259–277.Google Scholar
6.Chow, E J, Friedman, D L, Stovall, Met al. Risk of thyroid dysfunction and subsequent thyroid cancer among survivors of acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2009; 53: 432–437.CrossRefGoogle ScholarPubMed
7.Bonato, C, Severino, R F, Elnecave, R H. Reduced thyroid volume and hypothyroidism in survivors of childhood cancer treated with radiotherapy. J Pediatr Endocrinol Metab 2008; 21: 943–949.Google Scholar
8.Sklar, C, Whitton, J, Mertens, Aet al. Abnormalities of the thyroid in survivors of Hodgkin's disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 2000; 85: 3227–3232.Google Scholar
9.van Santen, H M, Thonissen, N M, de Kraker, Jet al. Changes in thyroid hormone state in children receiving chemotherapy. Clin Endocrinol (Oxf) 2005; 62: 250–257.CrossRefGoogle Scholar
10.Paulides, M, Dörr, H G, Stöhr, Wet al. Late Effects Surveillance System. Thyroid function in paediatric and young adult patients after sarcoma therapy: a report from the Late Effects Surveillance System. Clin Endocrinol (Oxf) 2007; 66: 727–731.Google Scholar
11.van Santen, H M, Vulsma, T, Dijkgraaf, M Get al. No damaging effect of chemotherapy in addition to radiotherapy on the thyroid axis in young adult survivors of childhood cancer. J Clin Endocrinol Metab 2003; 88: 3657–3663.CrossRefGoogle ScholarPubMed
12.Schmiegelow, M, Feldt-Rasmussen, U, Rasmussen, A Ket al. A population-based study of thyroid function after radiotherapy and chemotherapy for a childhood brain tumor. J Clin Endocrinol Metab 2003; 88: 136–140.Google Scholar
13.Nishiyama, K, Kozuka, T, Higashihara, Tet al. Acute radiation thyroiditis. Int J Radiat Oncol Biol Phys 1996; 36: 1221–1224.Google Scholar
14.Katz, M H. Multivariable analysis: a practical guide for clinicians. Cambridge: Cambridge University Press, 2003.Google Scholar
15.Bakhshandeh, M, Hashemi, B, Mahdavi, S Ret al. Evaluation of thyroid disorders during head-and-neck radiotherapy by using functional analysis and ultrasonography. Int J Radiat Oncol Biol Phys 2012; 83: 198–203.CrossRefGoogle ScholarPubMed
16.Djemli, A, Van Vliet, G, Belgoudi, Jet al. Reference intervals for free thyroxine, total triiodothyronine, thyrotropin and thyroglobulin for Quebec newborns, children and teenagers. Clin Biochem 2004; 37: 328–330.Google Scholar
17.Elmlinger, M W, Kuhnel, W, Lambrecht, H Get al. Reference intervals from birth to adulthood for serum thyroxine (T4), triiodothyronine (T3), free T3, free T4, thyroxine binding globulin (TBG) and thyrotropin (TSH). Clin Chem Lab Med 2001; 39: 973–979.Google Scholar
18.Blitzer, J B, Paolozzi, F P, Gottlieb, A Jet al. Thyrotoxic thyroiditis after radiotherapy for Hodgkin's disease. Arch Intern Med 1985; 145: 1734–1735.Google Scholar
19.Bryer-Ash, M, Lodhi, W, Robbins, Ket al. Early thyrotoxic thyroiditis after radiotherapy for tonsillar carcinoma. Arch Otolaryngol Head Neck Surg 2001; 127: 209–211.Google Scholar