Alterations in thyroid hormone metabolism during chemotherapy in patients with testicular carcinoma

In a prospective study, the effects of chemotherapy on thyroid function in patients with non-seminoma testicular carcinoma were evaluated. Thirty-one patients were studied; in sixteen immunoassayable HCG was present, but altered thyroid function could not be established. In fifteen patients an exaggerated TSH response to TRH was observed. In these patients, although T3 and T4N values were normal, basal TSH levels were higher compared to patients with a normal TSH response, probably due to preceding lymphangiography. During chemotherapy, T4N, T3 and rT3 levels rose significantly, but basal TSH levels and the TSH response to TRH decreased. In contrast, the prolactin responses to TRH increased. The observed changes in thyroid function during chemotherapy appear to result from delayed thyroid hormone clearance, probably caused by an effect of chemotherapy on deiodinating enzyme activity. This would result, in an increase in T4N and rT3 levels and a fall in TSH levels and in the TSH response to TRH. Furthermore, after therapy the raised T4N and lowered TSH levels remained, whilst the FT3 level did not change either during or after therapy, suggesting an unaltered hypothalamic/pituitary axis.