It is known that radiotherapy (Rx) has a dose-dependent deleterous effect on the thyroid gland. Primary hypothyroidism occurs in 20 to 70% of H and it becomes evident late, between 3-6 years post-Rx. In this work, thyroid function was evaluated in H (n=62, range of chronological age: 4.52-17.3 years). According to prognosis of H (GATLA score). 3 groups were defined: A)Favorable, n=14, B)intermediate, n=33, and C)disfavorable, n=15. Every group was subdivided according to time after the end of treatment in, ST (<6 months) and LT (>6, range 6 to 96 months). Methods: TRH-TSH test(μUl/ml), T4 (mcgr/dl), T3 (ng/ml), thyroid antibodies (Tab) by hemagglutination. Hypothyroidism was considered whenever an inequivocal alteration of TRH-TSH was detected (Basal TSH>5μlU/ml, and response>30 μlU/ml). Group 1 received only chemotherapy (Chem). Group B, Rx + Chem, and Group C. Rx + aggressive Chem. Rx dose was similar in B and C. Results: Incidence of hypothyroidism A)ST: 1/4, LT 2/10 (Fisher's exact test. ST vs LT p=ns; B)ST 10/15, LT 11/18 (p=ns); C)ST 1/7, LT 6/8(p=0.04). There was no significant difference between A, B or C in neither ST or LT in T4 and T3. Only 6/62 H had high titers of Tab. H ST there was significantive difference only in B vs C (p=0.02) while at LT, it was found in A vs B (p=0.05) and in A vs C (p=0.05). The difference between B and C at ST is probably related to immunological or genetic differences in the population and not to the dose of Rx which was similar in both groups. The frequency of hypothyroidism in Group A at ST and at LT (25%) is higher than in the juvenile population (2%) supporting the concept of genetic or immunological predisposing factors in H. A deficiency of suppressor T lymphocytes (T-S) in the pathogenesis of autoimmune thyroid disease has been shown. Furthermore, T-S are highly cooperative while T-helper lymphocytes, which cooperate with B lymphocytes in the production of antibodies are not resistant. On the other hand. Chem would induce damage in B lymphocyte clones being formed at the time, producing a definitive lesion in the gland and explaining the low Tab titers. The high incidence of hypothyroidism in Group C at LT is probably related to the known delayed effect of Rx in addition to the use of aggressive Chem which includes adriamicine, a thyrotoxic cytostatic.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vaiani, E., Belgorosky, A., Mendilaharzu, H. et al. Short(St) and Long Term (Lt) Thyroid (T) Dysfunction After Treatment in Patients With Hodgkin's Disease (H) With Different Agressive Scores. Pediatr Res 41, 306 (1997). https://doi.org/10.1203/00006450-199702000-00058
Issue Date:
DOI: https://doi.org/10.1203/00006450-199702000-00058