ESPEYB21 9. Oncology and Chronic Disease Thyroid Issues in Cancer Survivors (3 abstracts)
9.10. Primary hypothyroidism in childhood cancer survivors treated with radiation therapy: a PENTEC comprehensive review
Milano MT , Vargo JA , Yorke ED , Ronckers CM , Kremer LC , Chafe SMJ , van Santen HM , Marks LB , Bentzen SM , Constine LS & Vogelius IR
Michael_Milano@urmc.rochester.edu
Int J Radiat Oncol Biol Phys. 2024 Jun 1;119(2):482-493. doi: 10.1016/j.ijrobp.2021.02.001. PMID: 33810948
Brief Summary: This review analysed 15 original studies reporting the effects of radiation therapy (RT) on thyroid gland in childhood cancer survivors (CCS). A relationship between RT dose to the thyroid gland and risk of hypothyroidism could be extrapolated from 8/15 studies. Risk of compensated hypothyroidism increased with RT dose to the thyroid: it was 12%, 25% and 44% at 10, 20 and 30 Gy, respectively. Similarly, the risk of overt hypothyroidism was 4%, 7% and 13% at 10, 20 and 30 Gy, respectively. There was no clear lower threshold RT dose of safety. Age >15 years at RT and female sex were associated with increased risk of hypothyroidism.
The thyroid gland is often an incidental target of RT in CCS, resulting in various functional impairments, nodularity and/or malignancy. Patients at risk for RT-induced hypothyroidism should undergo regular monitoring of thyroid function, physical examination and ultrasound imaging to assess the emergence of nodules. Hypothyroidism occurs generally within the first 5 years after RT, but some studies report a precocious onset when high RT doses were used, while other studies reported a later onset 5 to 10 years after RT. This study confirmed a RT dose-response relationship with the risk of hypothyroidism, without any safe lower threshold dose. For this reason, thyroid RT exposure should be minimized when feasible, and regular monitoring should be performed in all CCS exposed to RT.
Volume 21
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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