TY - JOUR
T1 - Radiation-induced thyroid changes
T2 - A retrospective and a prospective view
AU - Massimino, Maura
AU - Gandola, Lorenza
AU - Mattavelli, Franco
AU - Pizzi, Natalia
AU - Seregni, Ettore
AU - Pallotti, Federica
AU - Spreafico, Filippo
AU - Marchianò, Alfonso
AU - Terenziani, Monica
AU - Cefalo, Graziella
AU - Biassoni, Veronica
AU - Meazza, Cristina
AU - Trecate, Giovanna
AU - Collini, Paola
PY - 2009/9
Y1 - 2009/9
N2 - Aim of the study: Incidental/therapeutic thyroid irradiation causes hypothyroidism and nodular disease. Increasing numbers of children are being cured of cancers by treatments that include radiation also involving the thyroid bed: these children warrant an early diagnosis and treatment of any radiation-related thyroid changes. Methods: In 1998 we retrospectively evaluated thyroid parenchyma/function in all patients irradiated between 1975 and 1997; thereafter, we prospectively evaluated all patients given thyroid irradiation by means of thyroid ultrasound and serum fT3, fT4, TSH and thyroglobulin. Results: Of 596 eligible patients, 468 agreed to the retrospective evaluation: 128/468 had one or more thyroid nodules, and 73 of these 128 had concomitant or previously untreated hypothyroidism, while 22/128 had a differentiated carcinoma. Another 144/157 patients treated between 1998 and 2004 were evaluated and any iatrogenic hypothyroidism was promptly treated: 19/144 had nodules, all smaller than 1 cm in diameter. The first patient group was studied retrospectively, so we have no precise record of the time of nodule occurrence or of their initial sizes. We found, however, that both the number of patients with nodules and the sizes of the nodules were significantly lower (p <0.01) in the prospectively studied group (after a median follow-up of 81 months) than in the retrospectively studied group. Among all the patients with nodules, significantly more females developed cancer than males (p <0.04). Conclusions: Early treatment for hypothyroidism and ultrasound evaluation of the parenchyma are needed to limit nodule onset and growth.
AB - Aim of the study: Incidental/therapeutic thyroid irradiation causes hypothyroidism and nodular disease. Increasing numbers of children are being cured of cancers by treatments that include radiation also involving the thyroid bed: these children warrant an early diagnosis and treatment of any radiation-related thyroid changes. Methods: In 1998 we retrospectively evaluated thyroid parenchyma/function in all patients irradiated between 1975 and 1997; thereafter, we prospectively evaluated all patients given thyroid irradiation by means of thyroid ultrasound and serum fT3, fT4, TSH and thyroglobulin. Results: Of 596 eligible patients, 468 agreed to the retrospective evaluation: 128/468 had one or more thyroid nodules, and 73 of these 128 had concomitant or previously untreated hypothyroidism, while 22/128 had a differentiated carcinoma. Another 144/157 patients treated between 1998 and 2004 were evaluated and any iatrogenic hypothyroidism was promptly treated: 19/144 had nodules, all smaller than 1 cm in diameter. The first patient group was studied retrospectively, so we have no precise record of the time of nodule occurrence or of their initial sizes. We found, however, that both the number of patients with nodules and the sizes of the nodules were significantly lower (p <0.01) in the prospectively studied group (after a median follow-up of 81 months) than in the retrospectively studied group. Among all the patients with nodules, significantly more females developed cancer than males (p <0.04). Conclusions: Early treatment for hypothyroidism and ultrasound evaluation of the parenchyma are needed to limit nodule onset and growth.
KW - Childhood radiotherapy
KW - Iatrogenic hypothyroidism
KW - Second tumours
KW - Thyroid late-effects
KW - Thyroid nodules
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U2 - 10.1016/j.ejca.2009.06.009
DO - 10.1016/j.ejca.2009.06.009
M3 - Article
C2 - 19608408
AN - SCOPUS:69249098587
VL - 45
SP - 2546
EP - 2551
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
IS - 14
ER -