Abnormalities of the thyroid in survivors of childhood Hodgkin's disease

Abstract

Aim: The progress made in the treatment of Hodgkin's disease (HD) has resulted in long-term survival rates >90%, therefore late sequelae of treatment, especially endocrine diseases, have become more important. Hypothyroidism is the most frequent thyroid disease but hyperthyroidism, thyroid nodules and cancer are also frequent. Thyroid cancer begins to appear 5-10 years after neck irradiation and risk persists for decades. Therefore it is important a careful and long-term follow-up of these patients.

Methods: This report analyzed the thyroid function of thirteen patients successfully treated for childhood HD according to three different protocols of therapy. Treatment modalities were correlated to the occurrence of thyroid dysfunction.

Results: After a median follow-up of 8.3 years, nine out of thirteen patients were found to have thyroid abnormalities. Six patients developed hypothyroidism, one patient developed hyperthyroidism, two patients showed only ultrasound abnormalities.

Conclusions: The patients treated with lower radiotherapy (RT) doses and restricted RT extension showed a lower incidence of thyroid abnormalities compared to patients treated with higher RT dose and extended RT field. This study, even though performed in a small cohort of patients, confirms the high incidence of thyroid abnormalities in patients treated for HD and strengthens the importance of a long-term follow-up.