Recurrence of Thyroid Nodules after Surgical Removal in Patients Irradiated in Childhood for Benign Conditions

Abstract

To determine the incidence of benign thyroid nodules and the risk factors for their recurrence after surgical removal, we followed 511 patients for 1 to 40.6 years (median, 11.2) after surgery for benign thyroid nodules arising after local irradiation for unrelated benign diseases in childhood. Recurrent thyroid nodules developed in 100 patients (19.5 percent). The risk of recurrence correlated inversely with the amount of thyroid tissue removed. Women had a higher recurrence rate than men (28.4 percent vs. 10.3 percent; P less than 0.05). Among the 299 patients who had been treated with thyroid hormone at the discretion of their physicians to suppress thyroid-stimulating hormone, 25 had recurrences (8.4 percent), as compared with 72 of 201 patients who did not receive thyroid hormone (35.8 percent) (hazard ratio taking into account the extent of surgery and the patient's sex, 2.5; 95 percent confidence interval, 1.5 to 4.1). Histologic analysis of the 73 tissue samples from patients with recurrences showed that 14 samples (19.2 percent) were malignant. Thyroid hormone treatment had no effect on the rate of thyroid cancer. We conclude that radiation-associated benign thyroid nodules have a high recurrence rate, similar to that reported among nonirradiated patients with benign thyroid nodules. We also conclude that treatment with thyroid hormone decreases the risk of benign recurrences, particularly in women, but not the risk of cancer.

Thyroid nodular disease after radiotherapy to the neck for childhood Hodgkin’s disease

“…However, resolution of focal lesions was seen only in the patients on thyroxine. Fogelfeld et al (1989), in a study of 511 patients who had surgery for benign thyroid nodules arising after radiotherapy to the neck for benign disease in childhood, demonstrated that treatment with thyroxine reduced the number of recurrences of benign nodules but did not affect the rate of thyroid cancer.…”

“…It has been shown by Fogelfeld et al (1989) that recurrence of thyroid nodules after surgical removal in patients irradiated in childhood for benign conditions is related to the amount of thyroid tissue remaining. In view of these findings and the continuing risk of malignant change in a previously irradiated thyroid gland, unilateral lobectomy in a patient with multiple focal abnormalities of the thyroid on ultrasound is of doubtful benefit as the patient will need to be on thyroxine and will also need to continue to have regular thyroid ultrasound scans.…”

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

“…Thyroid hormone has also been used in pediatric patients with radiation-induced thyroid nodules in which the formation of subsequent nodules has been shown to be reduced (148,149). It is not clear if this data can be extrapolated to pediatric patients with spontaneous nodules, and LT 4 therapy had no effect on the incidence of thyroid cancer (148).…”

Thyroid Nodules 2006: Managing what has been known for over 50 years

“…29 More recently, around the time the utility of suppression therapy began to be called into question, Fogelfeld reported that irradiated patients treated with suppression therapy after subtotal thyroidectomy developed fewer benign (not malignant) thyroid nodules than those who were not treated with thyroid hormone. 30 …”