Structural and functional changes in the thyroid gland in the early and late periods after radiation therapy
Background: Recently, more and more attention has been paid to the study of acute and late consequences of cancer treatment. To date, a small number of studies on thyroid dysfunction in the acute period after radiation therapy (RT) to the neck and supraclavicular lymph nodes have been published in the literature.I.I. Amergulov, M.G. Pavlova, Yu.P. Sych, Yu.R. Zhuravleva, M.M. Dolov, M.T. Berdyklychev, V.Z. Dobrokhotova, E.O. Sannikova, O.P. Trofimova, M.V. Orlova, D.A. Kuznetsova, N.M. Bychkova, N.A. Zaitseva, E.Yu. Kandakova, V.M. Sotnikov, E.G. Ryzhkova, V.V. Fadeev
Objective: Assessment of the prevalence of structural and functional changes in the thyroid gland in the acute period after RT for head and neck cancer (HNC) and breast cancer (BC).
Materials and methods: The prospective study included 35 patients, median age – 46 years [41; 49]: 14 patients with HNSCC (7 men and 7 women) and 21 patients with BC. The study of the TSH, free T4, thyroglobulin levels and thyroid ultrasound were performed before the start of RT, immediately after its completion and 6 months later.
Results: In three patients (8.57%), destructive thyroiditis was detected immediately after the completion of RT – subclinical thyrotoxicosis was registered in one patient with HNSCC and in one patient with BC. Another patient with BC had a hypothyroid phase of destructive thyroiditis. In all three cases, the patients did not present any complaints, and the laboratory parameters reached the reference values during the repeat examination after 6 months. When comparing the parameters over time, a significant decrease in the thyroid gland volume was noted immediately after RT compared to the volume before RT (p=0.043). After 6 months, 2 cases of hypothyroidism (5.71%) were noted: one case of subclinical hypothyroidism after treatment for BC and one case of manifest hypothyroidism after treatment for HNC.
Conclusion: In the early period after RT, destructive thyroiditis may develop, which has no clinical manifestations and resolves spontaneously within a few months. After 6 months, the risk of hypothyroidism increases, requiring replacement therapy.
Keywords
post-radiation hypothyroidism
head and neck cancer
breast cancer
radiation therapy
About the Authors
Ilya I. Amergulov, Postgraduate Student, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ilya_a94@mail.com, ORCID https://orcid.org/0000-0001-8637-1483 (corresponding author)Maria G. Pavlova, Cand. Sci. (Med.), Associate Professor at the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; mgp.doc@yandex.ru, ORCID: https://orcid.org/0000-0001-6073-328X
Yulia P. Sych, Cand. Sci. (Med.), Associate Professor at the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; juliasytch@mail.ru, ORCID: https://orcid.org/0000-0002-7000-0095
Yulia R. Zhuravleva, 5th year student of the Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; zhjulia03@list.ru, ORCID: https://orcid.org/0009-0007-5466-6165
Magomed M. Dolov, Radiotherapist, Department of Radiation Therapy, Moscow International Oncology Center, Moscow, Russia; ORCID:
https://orcid.org/0009-0004-5039-7875
Mergen T. Berdyklychev, Oncologist, Outpatient Department of Extra-Budgetary Medical Activities, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; ORCID: https://orcid.org/0000-0002-6646-8728
Valentina Z. Dobrokhotova, Cand. Sci. (Med.), Associate Professor at the Department of Oncology, I.M. Sechenov First Moscow State Medical University (Sechenov University); Oncologist, Surgical Department of Head and Neck Tumors, N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; ORCID: https://orcid.org/0000-0001-5889-392X
Ekaterina O. Sannikova, Medical Physicist, Department of Radiation Therapy, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; ORCID: https://orcid.org/0009-0002-5249-3751
Oksana P. Trofimova, Dr. Sci. (Med.), Leading Researcher, Department of Radiation Therapy, N.N. Blokhin National Medical Research Center of Oncology, Radiotherapist, Professor at the Department of Oncology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; ORCID: https://orcid.org/0000-0002-7204-370X
Maria V. Orlova, Radiotherapist, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center, Moscow, Russia; ORCID: https://orcid.org/0000-0002-8213-4461
Daria A. Kuznetsova, Radiotherapist, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center, Moscow, Russia; ORCID: https://orcid.org/0009-0009-1008-9583
Natalia M. Bychkova, Cand. Sci. (Med.), Head of the Day Hospital, Division of Radiation Therapy, Radiotherapist, Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center, Moscow, Russia; ORCID: https://orcid.org/0000-0002-5177-2612
Natalia A. Zaitseva, Head of the Physicotechnical Department, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center, Moscow, Russia; ORCID: https://orcid.org/0000-0002-2764-5189
Elena Yu. Kandakova, Dr. Sci. (Med.), Head of the 70-bed Radiation Therapy Department with a 30-bed Day Hospital of the Radiation Therapy Clinic, Russian Research Center of Roentgenology and Radiology, Moscow, Russia; https://orcid.org/0000-0001-7127-7881
Vladimir M. Sotnikov, Dr. Sci. (Med.), Head of the Division of MASC, Russian Research Center of Roentgenology and Radiology, Moscow, Russia; ORCID: https://orcid.org/0000-0003-0498-314X
Ekaterina G. Ryzhkova, Postgraduate Student, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0003-0069-1692
Valentin V. Fadeev, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-3026-6315
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