Thyroid Functions in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy and Radiotherapy - Original Article

Abstract

Objective: Post-treatment endocrine disturbances are common in cancer patients who have received radiotherapy or chemotherapy. The objective of this study was to evaluate the thyroid functions of long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy and radiotherapy.Methods: Thyroid functions of 55 Hodgkin’s lymphoma patients (M/F:2.05/1) in complete remission were evaluated retrospectively.Results: The mean age of the patients at diagnosis was 10.35±4.09 (range: 2.83-17) years and the mean follow-up period was 5.54±3.68 (range: 0.92-13.92) years. All patients received chemotherapy; a total of 50 patients (90.9%) underwent radiotherapy, 42 (76.4%) of whom received neck/mantle radiotherapy. Thyroid function tests were abnormal in 14 (24.5%) patients and normal - in the remaining 41 (74.5%). A diagnosis of subclinical and overt hypothyroidism was made in 11 (78.6%) and 3 (21.4%) patients with abnormal thyroid function tests, respectively. Nearly one-fourth (21.4%) of all thyroid function disorders were detected in the first year of follow-up. A statistically significant correlation was found between the dose of mantle radiotherapy and thyroid function disorder (p=0.002). In addition, statistically significant correlations were established between thyroid examination or thyroid ultrasonography findings and thyroid functions (p <0.001 or p=0.006, respectively).Conclusions: Radiation-induced thyroid disorders may develop in pediatric Hodgkin’s lymphoma patients in complete remission starting as early as the first year after treatment and are dose-dependent. Patients, particularly those who have been exposed to radiotherapy of the neck, must be followed up closely for occurrence of thyroid dysfunctions.Conflict of interest:None declared.

Clinical Characteristics and Treatment Outcomes in Children, Adolescents, and Young-adults with Hodgkin's Lymphoma: a KPHOG Lymphoma Working-party, Multicenter, Retrospective Study

“…Endocrine problems commonly experienced in HL survivors include thyroid dysfunction, decreased bone mineral density, and gonadal dysfunction, which are highly influenced by alkylating agents and radiotherapy. 30 31 Furthermore, fertility preservation and reproductive health are significant concerns in adolescents and young adults with HL. 32 However, we found no reported cases of this complication in our study, although this outcome may have been underdiagnosed.…”

Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma

“…Geç döneme ait bu yan etkiler tanımlanmıştır, ancak hangi hastada, hangi tedavi protokolünün, hangi tip bozukluğa yol açtığını belirleyen risk faktörleri üzerinde halen tartışılmaktadır. Çocukluk çağı Hodgkin lenfoma hastalarında boyun bölgesine uygulanan RT sonrası %40'a kadar geniş bir oranda hipotiroidi, tiroid nodülü ve tiroid kanseri gibi tiroid anomalileri gözlenmiştir (7)(8)(9)(10)(11) . Hodgkin Lenfoma sağ kalanlarında tiroid işlevlerini inceleyen bu çalışmada tiroid fonksiyon bozukluğu oranı %40 olarak saptanmıştır (10) .…”

“…Demirkaya ve ark. (9) 2011 yılında 55 Hodgkin lenfoma tedavi almış hasta ile yaptıkları çalışmada ortalama nodül oluşma zamanı 5.5 yıl olup 4 hastada (%7.4) tiroid nodülü saptamışlardır. Bizim çalışmamızda 5 hastanın (%12,5) tiroid ultrasonografisinde nodül saptandı ve ortalama nodül gelişme zamanı 8,9 yıldı.…”

Hodgkin Lymphoma in Children and Adolescents: Advances in Pathology, Diagnosis, and Treatment Strategies

“…In addition, statistically significant correlations were established between thyroid clinical examination, thyroid ultrasonography findings and thyroid function tests (P < 0.001 and P = 0.006, respectively). [77]…”