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Subtle primary hypothyroidism in patients treated for acute lymphoblastic leukemia
T Pasqualini1, J McCalla, S Berg
1Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Acta Endocrinologica
|April 1, 1991
Summary
Children treated for acute lymphoblastic leukemia often develop subtle primary hypothyroidism, particularly after craniospinal irradiation. Thyroid hormone levels and thyroid-stimulating hormone (TSH) responses indicate thyroid dysfunction post-treatment.
Area of Science:
- Endocrinology
- Pediatric Oncology
- Radiation Oncology
Background:
- Radiation therapy for acute lymphoblastic leukemia (ALL) can impact thyroid function.
- Long-term effects of cranial and craniospinal irradiation on the endocrine system are a concern in pediatric cancer survivors.
Purpose of the Study:
- To evaluate thyroid hormone levels, thyroid antibodies, thyrotropin-releasing hormone (TRH) response, and circadian pattern of thyroid-stimulating hormone (TSH) in children and adolescents post-ALL radiation therapy.
- To identify potential thyroid dysfunction in this patient cohort.
Main Methods:
- Assessed serum total T4, free T4, T3, and thyroid antibodies.
- Measured serum TSH response to TRH stimulation.
- Monitored circadian patterns of serum TSH.
- Compared results to a control population.
Main Results:
- All patients had normal total T4, T3, and negative thyroid antibodies.
- Four patients receiving craniospinal irradiation had low free T4 levels.
- Elevated basal and TRH-stimulated TSH levels were observed in a significant proportion of patients, especially those treated with craniospinal irradiation.
- Abnormal circadian TSH patterns were noted in some patients.
Conclusions:
- Subtle primary hypothyroidism is common in pediatric ALL survivors treated with radiation therapy.
- Craniospinal irradiation poses a higher risk for developing thyroid dysfunction compared to cranial irradiation.
- Regular thyroid function monitoring is crucial for these patients.