Thyroid Dysfunction Following Management of Non-thyroid Head and Neck Cancers

Original Article

Abstract

Head and neck cancers are one of the commonest malignancies in India. Majority of cases of head and neck malignancy undergo chemoradiation with or without surgery. Thyroid bears the brunt in terms of either excision or the gland tends to get irradiated and fibrosed. In either scenario the functionality of gland is lost leading to hypothyroidism and other clinical manifestations. It tends to get subclinical and goes unnoticed. To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine use of thyroid function tests during follow up. It was a prospective non randomized control study of 100 patients of head and neck cancer receiving radiotherapy for duration of 1 year. Thyroid stimulating hormone and T3 and T4 estimations were done at baseline and at 3 and 9 months following radiotherapy. Out of 100 patients, 72 (72%) were males and 28 (28%) were females. All the patients received radiation to the neck to a dose of > 30 Gy. 35 patients received concurrent chemotherapy. 11 patients were found to have subclinical hypothyroidism while 32 patients developed significant clinical hypothyroidism (P value of 0.001). Thus a total of 43 patients developed radiation induced hypothyroidism. 20 of the 32 patients who developed clinical hypothyroidism were in the age group of 41–50 years. 11 of 32 patients who developed clinical hypothyroidism received chemoradiation while rest 21 received radiotherapy alone. Mean period for developing radiation induced hypothyroidism was 4.5 months. Hypothyrodism (clinical or subclinical) is an under recognised morbidity of external radiation to the neck which is seen following a minimum dose of 30 Gy to the neck. Recognising hypothyroidism (clinical or subclinical) early and treating it prevents thyroid dysfunction related complications. Hence, thyroid function tests should be made routine during follow up in all patients undergoing radiotherapy.

Keywords

Head and neck malignancy Hypothyroidism Radiotherapy 

Notes

Compliance with Ethical Standards

Conflict of interest

Both authors declare that they have no conflict of interest.

Ethical Approval

All the procedures that were performed were in accordance with the ethical standards of institution and was approved by the ethical committee.

Informed Consent

Written and Informed consent was taken from all individual participants which were included in the study.

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C et al (2006) Cancer statistics 2006. CA Cancer J Clin 56:106–130CrossRefPubMedGoogle Scholar
  2. 2.
    Grover EA, Christie AC, Merritt EA (1929) Roentgen radiation in the treatment of hyperthyroidism: a statistical evaluation based on 305 cases. JAMA 92(21):1730–1734CrossRefGoogle Scholar
  3. 3.
    Nishiyama K, Tanaka E, Tarui Y, Miyauchi K, Okagawa K (1996) A Prospective analysis of subacute thyroid dusfunction after neck irradiation. Int J Radiat Oncol 34:439–444CrossRefGoogle Scholar
  4. 4.
    Sinard RJ, Tobin EJ, Mazzaferri EL, Hodgson SE, Young DC, Kunz AL et al (2000) Hypothyroidism after treatment for non thyroid head and neck cancer. Arch Otolaryngol Head Neck Surg 126:652–657CrossRefPubMedGoogle Scholar
  5. 5.
    Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F et al (1977) The spectrum of thyroid disease in a community: the Wickham survey. Clin Endocrinol 7:481–493CrossRefGoogle Scholar
  6. 6.
    Rodondi N, Newman AB, Vittinghoff E, de Rekeneire N, Satterfield S, Harris TB et al (2005) Subclinincal hypothyroidism and the risk of heart failure, other cardiovascular events and death. Arch Int Med 165:2460–2466CrossRefGoogle Scholar
  7. 7.
    Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC (2000) Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Int Med 132:270–278CrossRefPubMedGoogle Scholar
  8. 8.
    Felix H, Dupre N, Drape M, Court L (1961) Long term influence of radiotherapy for cancer of larynx on the appearance of Myxedema. Lyon Med 93:1043–1050PubMedGoogle Scholar
  9. 9.
    Bhandare N, Kennedy L, Malyapa RS, Morris CG, Mendenhall WM (2007) Primary and central hypothyroidism after radiotherapy for head and neck tumours. Int J Radiat Oncol 68:1131–1139CrossRefGoogle Scholar
  10. 10.
    Einhorn J, Wikholm G (1967) Hypothyroidism after external irradiation to the thyroid region. Radiology 88:326–328CrossRefPubMedGoogle Scholar
  11. 11.
    Glatstein E, McHardy-Young S, Brast N, Eltringham JR, Kriss JP (1971) Alterations in serum thyrotropin (TSH) and thyroid function following radiotherapy in patients with malignant lymphoma. J Clin Endocrinol 32:833–841CrossRefGoogle Scholar
  12. 12.
    Alterio D, Jereczek-Fossa BA, Franchi B, D’Onofrio A, Piazzi V, Rondi E et al (2007) Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients. Int J Radiat Oncol 67:144–150CrossRefGoogle Scholar
  13. 13.
    Perez and Brady's (2013) Principles and practice of radiation oncology, 6th edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  14. 14.
    Liening DA, Duncan NO, Blakeslee DB, Smith DB (1990) Hypothyroidism following radiotherapy for head and neck cancer. Otolaryngol Head Neck Surg 103:10–13CrossRefPubMedGoogle Scholar
  15. 15.
    Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol 21:109–122CrossRefGoogle Scholar
  16. 16.
    Tell R, Sjödin H, Lundell G, Lewin F, Lewensohn R (1997) Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol 39:303–308CrossRefGoogle Scholar
  17. 17.
    Aich RK, Deb AR, Pal S, Naha BL, Ray A (2005) Latrogenic hypothyroidism: a consequence of external beam radiotherapy to the head neck malignancies. J Cancer Res Ther 1:142–146CrossRefPubMedGoogle Scholar
  18. 18.
    Bhatia S, Ramsay NK, Bantle JP, Mertens A, Robison LL (1996) Thyroid abnormalities after therapy for Hodgkin’s disease in childhood. Oncologist 1:62–67PubMedGoogle Scholar
  19. 19.
    Turner SL, Tiver KW, Boyages SC (1995) Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol 31:279–283CrossRefGoogle Scholar
  20. 20.
    Mercado G, Adelstein DJ, Saxton JP, Secic M, Larto MA, Lavertu P (2001) Hypothyroidism: a frequent event after radiotherapy and after radiotherapy with chemotherapy for patients with head and neck carcinoma. Cancer 92:2892–2897CrossRefPubMedGoogle Scholar
  21. 21.
    Colevas AD, Read R, Thornhill J, Adak S, Tishler R, Busse P et al (2001) Hypothyroidism incidence after multimodality treatment for stage III and IV squamous cell carcinomas of the head and neck. Int J Radiat Oncol 51:599–604CrossRefGoogle Scholar
  22. 22.
    Posner MR, Ervin TJ, Miller D, Fabian RL, Norris CM Jr, Weichselbaum RR et al. (1984) Incidence of hypothyroidism following multimodality treatment for advanced squamous-cell cancer of the head and neck. Laryngoscope 94:451–454CrossRefPubMedGoogle Scholar
  23. 23.
    Tell R, Lundell G, Nilsson B, Sjödin H, Lewin F, Lewensohn R (2004) Long term incidence of hypothyroidism after radiotherapy in patients with head and neck cancer. Int J Radiat Oncol 60:395–400CrossRefGoogle Scholar
  24. 24.
    Hancock SL, McDougall IR, Constine LS (1995) Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol 31:1165–1170CrossRefGoogle Scholar
  25. 25.
    Koc M, Capoglu I (2009) Thyroid dysfunction in patients treated with radiotherapy for neck. Am J Clin Oncol 32:150–153CrossRefPubMedGoogle Scholar
  26. 26.
    Cooper DS (2001) Subclinical hypothyroidism. N Engl J Med 345:260–265CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of Surgical Oncology (Head and Neck Services)The Gujarat Cancer Research Institute (GCRI)AhmedabadIndia

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