THYROID-DISEASES AFTER TREATMENT OF HODGKINS-DISEASE
THYROID-DISEASES AFTER TREATMENT OF HODGKINS-DISEASE
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DOI：
10.1056/nejm199108293250902
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发表时间：
1991-08-29
影响因子：
158.5
通讯作者：
MCDOUGALL, IR
中科院分区：
文献类型：
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作者：
HANCOCK, SL;COX, RS;MCDOUGALL, IR
研究背景和方法。甲状腺疾病，尤其是甲状腺功能减退症，在接受过放射治疗的霍奇金氏病患者中很常见。我们回顾了1961年至1989年间在斯坦福大学接受放射治疗(810例)、放疗和化疗(920例)或单纯化疗(57例)的1787例霍奇金病患者(740名女性和1047名男性)的记录。在这些患者中，1533人在最后一次随访时还活着，254人死于霍奇金氏病以外的原因。另外四名患者被排除在分析之外，因为他们在治疗霍奇金氏病之前接受了甲状腺切除术。对1677名患者进行了甲状腺放射治疗。平均随访9.9年。共有573名患者有甲状腺疾病的临床或生化证据。在1677名接受甲状腺照射的患者中，治疗20年后患甲状腺疾病的精算风险为52%，26年后为67%。甲状腺功能减退513例。共有486名患者因血清促甲状腺激素浓度升高而接受甲状腺激素治疗，其中208名患者的游离甲状腺激素水平较低(208名患者)或278名患者的游离甲状腺素值正常(278名患者)；27名患者的血清促甲状腺激素水平有一过性升高，但未予治疗。30名患者出现了Graves‘s甲亢(其中2名患者没有接受过甲状腺放射治疗)，其中17名患者出现了眼病。另外4例Graves病患者在甲状腺功能减退(n=3)或甲状腺功能正常(n=1)期间出现眼病。患Graves病的风险是正常人的7.2~20.4倍。6例患者发生无症状甲状腺炎合并甲状腺毒症。44例患者发现有单个或多个甲状腺结节，其中26例接受了甲状腺切除术。44例中有6例患有乳头状癌或滤泡癌。未手术患者中，功能性小结节12例，囊性4例，多结节状甲状腺肿2例。甲状腺癌的精算风险为1.7%。患甲状腺癌的风险是预期风险的15.6倍。在霍奇金氏病患者接受放射治疗25年后，甲状腺疾病的高风险仍然存在，这加强了继续进行临床和生化评估的必要性。长期的随访证实了这些患者患甲状腺癌和Graves病以及甲状腺功能减退症的风险增加。
Background and Methods. Thyroid disease, especially hypothyroidism, is common in patients with Hodgkin's disease who have been treated with irradiation. We reviewed the records of 1787 patients (740 women and 1047 men) with Hodgkin's disease who were treated with radiation therapy alone (810 patients), radiation and chemotherapy (920 patients), or chemotherapy alone (57 patients) at Stanford University between 1961 and 1989. Among these patients, 1533 were alive at the last follow-up, and 254 had died of causes other than Hodgkin's disease. Four other patients were excluded from the analysis because they had undergone thyroidectomy before treatment for Hodgkin's disease. The thyroid was irradiated in 1677 patients. Follow-up averaged 9.9 years.Results. A total of 573 patients had clinical or biochemical evidence of thyroid disease. Among the 1677 patients whose thyroid was irradiated, the actuarial risk of thyroid disease 20 years after treatment was 52 percent, and it was 67 percent at 26 years. Hypothyroidism was found in 513 patients. A total of 486 patients received thyroxine therapy for elevated serum thyrotropin concentrations and either low free thyroxine (208 patients) or normal free thyroxine values (278 patients); 27 had transient elevations of the serum thyrotropin level that were not treated. Graves' hyperthyroidism developed in 30 patients (2 of whom had not undergone thyroid irradiation), and ophthalmopathy developed in 17 of these patients. Ophthalmopathy developed in four other patients with Graves' disease during a period of hypothyroidism (n = 3) or euthyroidism (n = 1). The risk of Graves disease was 7.2 to 20.4 times that for normal subjects. Silent thyroiditis with thyrotoxicosis developed in six patients. Forty-four patients were found to have single or multiple thyroid nodules, 26 of whom underwent thyroidectomy. Six of the 44 had papillary or follicular cancers. Among the patients who did not undergo operation, 12 had small functioning nodules, 4 had cysts, and 2 had multinodular goiters. The actuarial risk of thyroid cancer was 1.7 percent. The risk of thyroid cancer was 15.6 times the expected risk.Conclusions. High risks of thyroid disease persist more than 25 years after patients have received radiation therapy for Hodgkin's disease, reinforcing the need for continued clinical and biochemical evaluation. Prolonged follow-up confirms an elevated risk of thyroid cancer and Graves' disease as well as hypothyroidism in these patients.