Thyroid Carcinoma in Man after Exposure to Ionizing Radiation

Socolow, Edward L.; Hashizume, Akane; Neriishi, Shotaro; Niitani, R.

doi:10.1056/nejm196302212680803

Cited by 130 publications

(13 citation statements)

References 10 publications

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“…16 The cause of thyroid carcinoma is not known but there are some known predisposing factors. Head and neck irradiation in childhood is a known predisposing factor, 8,17 mainly for papillary type, but none of our patients had irradiation history. There is also experimental evidence suggesting an association between prolonged high levels of TSH and thyroid follicular adenoma and carcinoma.…”

Section: Discussionmentioning

confidence: 76%

Causes of Goiter in the Asir Region: A Histopathological Analysis of 361 Cases

Abu-Eshy

Alshehri

Khan

et al. 1995

Annals of Saudi Medicine

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The incidence and pattern of thyroid diseases in Saudi Arabia are not well known due to the lack of a national registry. Few studies were reported describing the pattern from non-mountainous regions of Saudi Arabia. [1][2][3][4] Asir is a high altitude territory and the pattern of thyroid diseases might be different. Indeed, we were struck by the unexpectedly high prevalence of malignancy in patients who underwent thyroidectomy for presumably benign goiter. We therefore decided to conduct this review in order to evaluate the pattern of surgically treated thyroid disease in the Asir area and compare it with other studies. Patients and MethodsAsir Central Hospital (ACH) is a referral hospital for the Asir Region of Saudi Arabia. The Department of Pathology at ACH is the main central laboratory, which receives specimens from 17 peripheral hospitals in the area. Over a period of six-and-one-half years, from January 1987 through June 1993, 361 thyroid specimens were received. The histopathological reports together with the age, sex, and nationality of the patients were reviewed. Statistical analysis was conducted using the SPSS/PC+ software package. Chi-square and Student's t-test were used at the 5% level of significance. ResultsAmong the 361 cases studied, 255 (70.6%) were Saudi nationals. The causes of goiter in surgically treated patients is shown in Table 1. The ages ranged from seven to 120 years (mean = 35.9±.13.8 years). Female patients constituted 81.7% of this series and the female to male ratio was 4.5:1. Multinodular goiter and adenoma (solitary nodule) constituted 68.3% of the cases, the latter being more common in young females (P<0.05). Toxic goiter was seen in 7.7% of patients and all of them either failed to respond or had recurrence after cessation of medical treatment. Autoimmune thyroiditis was seen in 23 (6.4%) patients, 16 of whom had Hashimoto thyroiditis (all except one were females) and the remaining seven patients had lymphocytic thyroiditis (two were males). In this series, there were three male patients (two Saudis and one Sudanese) who were diagnosed as dyshormonogenesis on the basis of high serum thyroid stimulating hormone (TSH) and diffuse hyperplasia on histopathological examination.Thyroid malignancy was found in 47 (13%) patients and the papillary carcinoma was the most common (65.9%) followed by thyroid lymphoma (21.3%); these findings are compared with other studies in Table 2. Four patients (40%) with lymphoma had an associated Hashimoto thyroiditis. The female to male ratio in patients with lymphoma was 4:1, the age range was 45 to 120 years (mean = 68.3 ± 22.3 years) and all were non-Hodgkin lymphoma.

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Section: Discussionmentioning

confidence: 76%

Causes of Goiter in the Asir Region: A Histopathological Analysis of 361 Cases

Abu-Eshy

Alshehri

Khan

et al. 1995

Annals of Saudi Medicine

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“…On the other hand, thyroid cancer appeared in substantial numbers in the 10 years or more after exposure among Japanese atomic bomb survivors [15][16][17]. In Marshallese, exposed to a mixture of radioiodines and gamma radiation, thyroid malignancies were detected 10-21 years after the nuclear explosion [18].…”

Section: Discussionmentioning

confidence: 99%

Childhood Thyroid Cancer: Comparison of Japan and Belarus.

et al. 1998

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Abstract. The high incidence of childhood thyroid cancer in Belarus is suspected to be due to radiation exposure after the Chernobyl reactor accident. To clarify the clinical and histological characteristics of childhood thyroid cancer in Belarus, we therefore compared these patients to a radiation non-exposed control series in Japan. In Belarus, 26 thyroid cancers in subjects aged 15 or younger were diagnosed among 25,000 screened between 1991 and 1995 by Chernobyl-Sasakawa Health and Medical Cooperation Project. The clinical and morphologic features of these 26 cases were compared to 37 childhood thyroid cancers in Japan diagnosed between 1962 and 1995. The age distribution at operation in Belarus showed a peak at 10 years old, with a subsequent fall in numbers. In contrast, the age distribution at operation in Japan showed a smooth increase between the ages of 8 and 14. The mean tumor diameter was smaller in Belarus than that in Japan (1.4 ± 0.7 vs. 4.1 ± 1.7 cm, P<0.001). The sex ratio, regional lymph node metastasis, extension to surrounding tissues or lung metastasis did not differ significantly. Histologically, all cases in Belarus were papillary and in Japan 33 cases were papillary and 4 cases were follicular carcinomas. Among papillary carcinomas, the frequency of a solid growth pattern, a criteria for classifying a tumor as poorly differentiated, was higher in Belarus than that in Japan (61.5 vs.18.2%, P<0.001). The difference between the features of childhood thyroid cancer in Japan and Belarus may be due to the difference in the process of carcinogenesis, but more direct evidence and further analysis by molecular epidemiology are needed in Belarussian cases.

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“…In the 1950s and early 1960s, the first publications appeared that associated external radiation exposure during childhood with cancer of the thyroid gland (1–3). Research has since shown that the young thyroid gland is particularly radiosensitive, that radiation-related risk increases with dose up to several Gray (Gy), then appears to level off and possibly decreases at doses in the 2–20 Gy range.…”

Section: Introductionmentioning

confidence: 99%

A Pooled Analysis of Thyroid Cancer Incidence Following Radiotherapy for Childhood Cancer

et al. 2012

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Childhood cancer five-year survival now exceeds 70–80%. Childhood exposure to radiation is a known thyroid carcinogen; however, data are limited for the evaluation of radiation dose-response at high doses, modifiers of the dose-response relationship and joint effects of radiotherapy and chemotherapy. To address these issues, we pooled two cohort and two nested case-control studies of childhood cancer survivors including 16,757 patients, with 187 developing primary thyroid cancer. Relative risks (RR) with 95% confidence intervals (CI) for thyroid cancer by treatment with alkylating agents, anthracyclines or bleomycin were 3.25 (0.9–14.9), 4.5 (1.4–17.8) and 3.2 (0.8–10.4), respectively, in patients without radiotherapy, and declined with greater radiation dose (RR trends, P = 0.02, 0.12 and 0.01, respectively). Radiation dose-related RRs increased approximately linearly for <10 Gy, leveled off at 10–15-fold for 10–30 Gy and then declined, but remained elevated for doses >50 Gy. The fitted RR at 10 Gy was 13.7 (95% CI: 8.0–24.0). Dose-related excess RRs increased with decreasing age at exposure (P < 0.01), but did not vary with attained age or time-since-exposure, remaining elevated 25+ years after exposure. Gender and number of treatments did not modify radiation effects. Thyroid cancer risks remained elevated many decades following radiotherapy, highlighting the need for continued follow up of childhood cancer survivors.

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Thyroid Carcinoma in Man after Exposure to Ionizing Radiation

Cited by 130 publications

References 10 publications

Causes of Goiter in the Asir Region: A Histopathological Analysis of 361 Cases

Causes of Goiter in the Asir Region: A Histopathological Analysis of 361 Cases

Childhood Thyroid Cancer: Comparison of Japan and Belarus.

A Pooled Analysis of Thyroid Cancer Incidence Following Radiotherapy for Childhood Cancer

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