Thyroid Sequelae of Pediatric Cancer Therapy

Area of Science:

• Endocrinology
• Oncology
• Pediatric Medicine

Background:

• The hypothalamic-pituitary-thyroid axis is vulnerable to damage from cancer treatments.
• Children undergoing cancer therapy face risks of thyroid-related late effects.
• Thyroid dysfunction and neoplasms can arise from radiation, radiopharmaceuticals, and novel therapeutics.

Purpose of the Study:

• To comprehensively review thyroid adverse effects in pediatric cancer survivors.
• To discuss screening and treatment strategies for these sequelae.

Main Methods:

• Literature review of thyroid sequelae following pediatric cancer treatment.
• Analysis of risks associated with external radiation, radiopharmaceuticals, tyrosine kinase inhibitors, and immune checkpoint inhibitors.
• Overview of clinical manifestations, screening protocols, and management approaches.

Main Results:

• External radiation therapy poses the highest risk for thyroid late effects.
• Radiopharmaceutical agents (e.g., 131I-metaiodobenzylguanidine) can also induce thyroid dysfunction and neoplasms.
• Novel cancer therapeutics (tyrosine kinase inhibitors, immune checkpoint inhibitors) are increasingly recognized causes of early thyroid dysfunction.
• Thyroid sequelae can manifest years to decades after treatment with indolent, non-specific symptoms.

Conclusions:

• Lifelong monitoring of childhood cancer survivors is paramount for early detection of thyroid disease.
• Prompt screening and appropriate management are essential to mitigate long-term thyroid morbidity.
• Understanding these adverse effects is critical for improving long-term outcomes in pediatric cancer survivors.