A CROSS-SECTIONAL STUDY OF THE ACUTE EFFECTS OF HEAD AND NECK RADIOTHERAPY ON THE THYROID VOLUME AND FUNCTION

Yıl 2020, Cilt: 22 Sayı: 1, 50 - 57, 30.04.2020

Fevziye İlknur Kayalı , Uğur Toprak , Rahşan Habiboğlu

https://doi.org/10.24938/kutfd.631176

Öz

Objective: To evaluate the acute effects of radiotherapy on the volume and function of the thyroid gland.

Material and Methods: Thirty-one patients with head and neck cancer were included in the study. Patients with thyroid cancer or thyroidectomy were excluded. There was no patient for whom radiotherapy was the only tretment modality. Thyroid function tests, thyroglobulin and thyroid volume imaging were evaluated before and immediately after radiotherapy, 

Results: After radiotherapy 13 patients had dysfunction. Among 13, 8 had subclinical hyperthyroidism, 1 had clinical hyperthyroidism, 1 had subclinical hypothyroidism and 3 developed clinical hypothyroidism. After chemoradiotherapy all patients had significantly decreased FT3 (p<0.001). FT4 slightly increased in all of the patients other than operated patients (p>0.05). After treatment, the TSH decreased in patients who were not operated but given chemotherapy whereas it was increased in patients who were operated but not given chemotherapy (p>0.05). The thyroid volume was unchanged in 2 patients, decreased in 17 patients and increased in 12 patients (p>0.05). There was no correlation between chemotherapy or surgery, and the volume of the thyroid gland. No thyroiditis was seen in the acute phase.

Conclusion: Hyperthyroidism appeared immediately after radiotherapy. The volume of the gland starts to be slightly affected in the acute phase. Due to possible clinical thyroid dysfunction, after completion of the radiotherapy patients should not be discharged without thyroid function tests.

Anahtar Kelimeler

Head and neck cancer, radiotherapy, Thyroid disfunction

Baş ve Boyun Radyoterapisinin Tiroid Volümü ve Fonksiyonu Üzerine Akut Etkileri Üzerine Kesitsel Bir Çalışma

Öz

Amaç: Radyoterapinin tiroid bezinin volümü ve işlevi üzerindeki akut etkilerini değerlendirmek.

Gereç ve Yöntemler: Çalışmaya baş boyun kanserli 31 hasta alındı. Tiroid kanseri veya tiroidektomili hastalar çalışma dışı bırakıldı. Radyoterapinin tek tedavi modalitesi olarak uygulandığı hiçbir hasta yoktu. Radyoterapiden hemen önce ve sonra tiroid fonksiyon testleri, tiroglobulin ve tiroid volüm görüntüleme yapıldı.

Bulgular: Radyoterapi sonrası 13 hastada disfonksiyon mevcuttu. On üç hastanın 8’inde subklinik hipertiroidi, 1’inde klinik hipertiroidi, 1’inde subklinik hipotiroidi ve 3’ünde klinik hipotiroidi vardı. Kemoradyoterapi sonrası tüm hastalarda anlamlı olarak azalmış FT3 mevcuttu (p<0.001). FT4, opere edilen hastalar dışındaki tüm hastalarda hafifçe artmış olarak saptandı (p>0.05). Tedavi sonrası, TSH, kemoterapi verilen ve opere edilmemiş hastalarda azalmışken, opere edilen ve kemoterapi verilmeyen hastalarda artmış olarak saptandı (p>0.05). İki hastada tiroid hacmi değişmedi, 17 hastada azaldı ve 12 hastada arttı (p>0.05). Kemoterapi veya cerrahi işlem ile tiroid bezinin hacmi arasında korelasyon yoktu. Akut fazda tiroidit görülmedi.

Sonuç: Hipertiroidinin radyoterapiden hemen sonra ortaya çıktığı sonucu gözlendi. Akut fazda bez hacmi hafifçe etkilenmeye başlar. Muhtemel klinik tiroid fonksiyon bozukluğu nedeniyle, radyoterapi tamamlandıktan sonra hastalar tiroid fonksiyon testleri yapılmadan taburcu edilmemelidir.

Anahtar Kelimeler

baş-boyun kanseri, radyoterapi, tiroid disfonksiyonu

Kaynakça

• 1. Hall EJ, Giaccia AJ. Radiobiology For The Radiologist. 7th ed. Philadelphia. JB Lippincott Co., 1994.
• 2. Jereczek-Fossa BA, Alterio D, Jassem J, Gibelli B, Tradati N, Orecchia R. Radiotherapy-induced thyroid dysfunctions. Cancer Treat Rev. 2004;30(4):369-84.
• 3. Miller M, Agrawal A. Hypothyroidism in post radiation head and neck cancer patients. Incidence, complications, and management. Curr Opin Otolaryngol Head Neck Surg. 2009;17(2):111-5.
• 4. Bajorunas DR, Ghavimi F, Jereb B, Sonenberg M. Endocrine sequelae of antineoplastic therapy in childhood head and neck malignancies. J Clin Endocrinol Metab.1980;50(2):329-35.
• 5. Posner MR, Ervin TJ, Miller D, Fabian RL, Norris CM Jr, Weichselbaum RR et al. Incidence of hypothyroidism following multimodality treatment for advanced squamous cell cancer of the head and neck. Laryngoscope. 1984;94(4):451-4.
• 6. Weissler MC, Berry BW. Thyroid stimulating hormone levels after radiotherapy and combined therapy for head and neck cancer. Head Neck. 1991;13(5):420-3.
• 7. Sinard RJ, TobinEJ, Mazzaferri EL, Hodgson SE, Young DC, Kunz AL et al. Hypothyroidism after treatment for nonthyroid head and neck cancer. Arch Otolaryngol Head Neck Surg. 2000;126(5):652-7.
• 8. Bhandare N, Kennedy L, Malyapa RS, Morris CG, Mendenhall WM. Primary and central hypothyroidism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys. 2007;68(4):1131-9.
• 9. Hancock SL, McDougall IR, Constine LS. Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol Biol Phys. 1995;31(5):1165-70.
• 10. Miller-Thomas MM, Kumar AJ, Sellin RV, Azimpoor S, Ang KK. The shrinking thyroid: how does thyroid size change following radiation therapy for laryngeal cancer? Am J Neuroradiol. 2009;30(3):613-6.
• 11. Bakhshandeh M, Hashemi B, Mahdavi SR, Nikoofar A, Edraki HR, Kazemnejad A. Evaluation of Thyroid Dysfunctions During Head-and-Neck Radiotherapy by Using Functional Analysis and Ultrasonography. Int J Radiat Oncol Biol Phys. 2012;83(1):198-203.
• 12. Koc M, Unuvar N, Sen RC, Capoglu I, Sen M. A prospective evaluation of early thyroid dysfunction on completion of neck radiotherapy. Oral Oncol. 2003;39(6):597-600. 13. Koc M, Capoglu I. Thyroid dysfunction in patients treated with radiotherapy for neck. Am J Clin Oncol. 2009;32(2):150-3.
• 14. Shyh-An Y. Radiotherapy for Head and Neck Cancer. Semin Plast Surg. 2010;24(2):127-36.
• 15. Lin Z, Yang Z, He B, Wang D, Gao X, Tam SY et al. Pattern of radiation-induced thyroid gland changes in nasopharyngeal carcinoma patients in 48 months after radiotherapy. PLoSOne. 2018;13(7):e0200310.
• 16. Diaz R, Jaboin JJ, Morales-Paliza M, Koehler E, Phillips JG, Stinson S et al. Hypothyroidism as a consequence of intensity- modulated radiotherapy with concurrent taxane-based chemotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2010;77(2):468-76.
• 17. Das TK, Das P, Das S, Jana A, Gupta P, Gupta P. A prospectivestudy of radiation- induced hypothyroidism in head and neck cancer patients. Tapas International Journal of Medical Science and Public Health. 2018;10(7):814-8.
• 18. Nishiyama K, Kozuka T, Higashihara T, Miyauchi K, Okagawa K. Acute radiation thyroiditis. Int J Radiat Oncol Biol Phys. 1996;36(5):1221-4.
• 19. Colevas AD, Read R, Thornhill J, Adak S, Tishler R, Busse P et al. Hypothyroidism incidence after multimodality treatment for stage III and IV squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys. 2001;51(3):599-604.
• 20. Smith GL, Smith BD, Garden AS, Rosenthal DI, Sherman SI, Morrison WH et al. Hypothyroidism in older patients with head and neck cancer after treatment with radiation: a population-based study. Head Neck. 2009;31(8):1031-8.
• 21. Celik M, Meral R, Kanliada D, Aydemir L, Basaran B, Kiyak E. Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned. Kulak Burun Bogaz Ihtis Derg. 2017;27(6):269-75.
• 22. Bethge W, Guggenberger D, Bamberg M, Kanz L, Bokemeyer C. Thyroidtoxicity of treatment for Hodgkin’s disease. Ann Hematol. 2000;79(3):114-8.
• 23. Srikantia N, Rishi KS, Janaki MG, Bilmagga RS, Ponni A, Rajeev AG et al. How common is hypothyroidism after external radiotherapy to neck in head and neck cancer patients? Indian J Med Paediatr Oncol. 2011;32(3):143-8.
• 24. Aich RK, Ranjan DA, Pal S, Naha BL, Amitabh R. Iatrogenic hypothyroidism: a consequence of external beam radiotherapy to the head and neck malignancies. J Cancer Res Ther. 2005;1(3):142-6.
• 25. Turner SL, Tiver KW, Boyages SC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 1995;31(2):279-83.
• 26. Cannon CR. Hypothyroidism in head and neck cancer patients: experimental and clinical observations. Laryngoscope. 1994(11);104:1-21.
• 27. LoGalbo AM, de Bree R, Kuik DJ, Lips PT, Mary B, VonBlomberg E et al. The prevalence of hypothyroidism after treatment for laryngeal and hypopharyngeal carcinomas: are autoantibodies of influence? Acta Otolaryngol. 2007;127(3):312-7.
• 28. Ricardi U, Corrias A, Einaudi S, Genitori L, Sandri A, diMontezemolo LC et al. Thyroid dysfunctionas a late effect in childhood medulloblastoma: a comparison of hyperfractionated versus conventionally fractionated craniospinal radiotherapy. Int J Radiat Oncol Biol Phys. 2001;50(5):1287-94.