Abstract
ObjectivesRadiation-induced hypothyroidism is the most common thyroid disorder after radiotherapy in nasopharyngeal carcinoma (NPC) patients. This study evaluated the pattern of radiation-induced thyroid gland changes in 48 months after radiotherapy in NPC patients and the association of hypothyroidism incidence with thyroid dose.MethodsFifty-six NPC patients treated by intensity modulated radiotherapy in 2013 were recruited. All patients received baseline thyroid hormones (fT3, fT4 and TSH) tests and CT scan before radiotherapy. Repeated measures of the thyroid hormones and gland volume were performed at 3, 6, 12, 18, 24, 30, 36 and 48 months after treatment. Trend lines of the thyroid volume and hormone level changes against time were plotted. The incidence of hypothyroidism patients and its relationship with the dose were also evaluated.ResultsThe mean thyroid volume followed a decreasing trend after radiotherapy, reaching a minimum (-39.8%) at 30 months and slightly increased afterward. The fT4 level followed a similar pattern with its mean value dropped by 21.5% at 30 months and became steady after 36 months. TSH level showed gradual rise from just after radiotherapy, reaching a peak at 24 months and became relatively steady after 36 months. The incidence of hypothyroidism increased to a maximum at 24 months (28.6%) and dropped afterwards. Thyroid Dmean and D50 were significantly correlated with hypothyroidism incidence in 12 to 30 months (ρ > 0.40, p < 0.05).ConclusionThe patterns of radiation induced thyroid volume shrinkage and fT4 level reduction were similar, with both of them showed decreasing trend from 0 to 30 months. The thyroid volume and function reached a relatively steady state after 36 months. The incidence of hypothyroidism increased up to 24 months and its frequency was associated with the thyroid dose.
Highlights
In radiotherapy of nasopharyngeal carcinoma (NPC), bilateral neck irradiation is necessary since neck lymphadenopathy has a high incidence (75–80%)[1]
Radiation-induced thyroiditis is considered as the primary damage to the thyroid gland when the follicular epithelial cells and blood vessels are damaged leading to hypothyroidism as late effect [3]
This study aimed to study the patterns of radiation-induced thyroid gland changes in NPC patients in first four years after radiotherapy by tracking the thyroid hormones and thyroid gland volume, and evaluate the association of incidence of hypothyroidism with the thyroid gland dose
Summary
In radiotherapy of nasopharyngeal carcinoma (NPC), bilateral neck irradiation is necessary since neck lymphadenopathy has a high incidence (75–80%)[1]. An anterior cervical field is used to treat the whole neck down to the supra-sternal notch, while for intensity modulated radiotherapy (IMRT), the planning target volume of the neck lymph nodes usually includes the nodal level IV, which is adjacent to the thyroid gland. Radiation induced thyroid disorders have been reported in post-radiotherapy head and neck cancer patients, such as short-term thyroiditis and long-term hypothyroidism [2, 3]. Radiation-induced thyroiditis is considered as the primary damage to the thyroid gland when the follicular epithelial cells and blood vessels are damaged leading to hypothyroidism as late effect [3]. The actual mechanism of radiation-induced thyroid damage is still uncertain and other causes including autoimmune reactions and parenchymal cell damages have been reported [4, 5]. Common symptoms of hypothyroidism include fatigue and weakness, cold intolerance, cognitive dysfunction, dry skin, constipation and depression, which can affect the quality of life of the post-radiotherapy patients [6]
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