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Thyroid storm after intensity-modulated radiation therapy: a case report and discussion
Roberto Diaz1, Marc D Blakey, Patrick B Murphy
1Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37211, USA.
The Oncologist
|March 17, 2009
Summary
Intensity-modulated radiation therapy (IMRT) can cause life-threatening thyroid storm in head and neck cancer patients. Early recognition is crucial due to overlapping symptoms with treatment toxicity.
Area of Science:
- Oncology
- Endocrinology
- Radiation Oncology
Background:
- Squamous cell carcinoma of the base of tongue is a common head and neck cancer.
- Induction chemotherapy followed by intensity-modulated radiation therapy (IMRT) is a standard treatment approach.
- IMRT involves precise radiation delivery but can affect nearby organs, including the thyroid.
Observation:
- A 43-year-old male patient developed symptoms of hyperthyroidism within 20 days post-IMRT.
- Severe thyrotoxicosis, consistent with thyroid storm, manifested 2.5 months after therapy completion.
- The patient's symptoms overlapped with expected cancer treatment toxicities, complicating diagnosis.
Findings:
- This case highlights a previously unreported complication of IMRT involving the thyroid gland.
- External-beam radiation, specifically IMRT, can precipitate hyperthyroidism and thyroid storm.
- Diagnostic challenges arise from symptom overlap between thyrotoxicosis and cancer therapy side effects.
Implications:
- Clinicians must consider thyroid storm as a potential complication in patients undergoing IMRT for head and neck cancers.
- Heightened awareness and vigilant monitoring are necessary for early diagnosis and management.
- This finding underscores the importance of considering endocrine-related adverse events in radiation oncology protocols.
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