Thyroid dysfunction in hodgkin's disease

• Published in: Cancer Vol. 63; no. 2; pp. 335 - 339
• Main Authors: Pasqualini, T., Iorcansky, S., Gruñeiro, L., Diez, B., Pavlovsky, S., Sackmann‐Muriel, F., Rivarola, M. A.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15.01.1989; Wiley-Liss
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Bleomycin - administration & dosage; Child; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Hematologic and hematopoietic diseases; Hodgkin Disease - complications; Hodgkin Disease - therapy; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Prednisone - administration & dosage; Procarbazine - administration & dosage; Thyroid Hormones - blood; Thyroiditis - etiology; Thyroiditis - immunology; Vinblastine - administration & dosage; Antineoplastic agent; Human; Iatrogenic; Thyroid diseases; Hodgkin disease; Autoimmune disease; Hemopathy; Thyroid gland; Radiotherapy; Chemotherapy; Complication; Neck; Hormonal investigation
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19890115)63:2<335::AID-CNCR2820630222>3.0.CO;2-C

Radiotherapy to the neck and/or polychemotherapy late effects on the thyroid were investigated in 51 patients (34 males and 17 females) with Hodgkin's disease. Except for two untreated, recently diagnosed patients, all were studied after 1 to 105 months (median, 27.5 months) of completion of polychemotherapy. Age ranged from 6.2 to 36.6 years (median, 13.6 years). Patients were divided according to treatment into four groups: (A) 13 patients treated with CVPP (cyclophosphamide, vinblastine, procarbazine, and prednisone); (B) 22 patients treated with CVPP plus radiotherapy (median radiation dose to the thyroid, 3000 cGy); (C) seven patients with ACOP/BVP (adriamycin, cyclophosphamide, vincristine, prednisone, bleomycin, vinblastine, procarbazine); and (D) seven patients treated with different polychemotherapy protocols, four of whom also received radiotherapy. Elevated basal and/or post‐TRH, ‐TSH levels were found in the following: Group A: two of 12 patients (17%); Group B: 11 of 22 (50%); Group C: four of seven (57%); and Group D: two of seven (28%). Positive antimicrosomal thyroid antibody titers (AM Ab) were found in the following: Group A: three of 12 patients (25%); Group B: six of 21 (28%), Group C: two of seven (28%); and Group D: one of six (17%). Of 46 patients studied, 12 (26%) had positive AM Ab; 37 of 46 patients were younger than 20 years of age, 11 (30%) of whom had positive AM Ab versus 4% in the normal population (P < 0.001). Two recently diagnosed, untreated patients had either high TSH response to TRH or positive AM Ab. In conclusion, higher frequency of thyroid dysfunction was observed in patients receiving radiotherapy (50% versus 27%). Prevalence of positive AM Ab, apparently unrelated to therapy, was higher in young patients than in the normal population. A predisposition to autoimmune thyroid disease seems to be present in these patients, but it is not possible to discern how lymphoma and thyroiditis are interrelated.