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Table 12. Thyroid Late Effectsa
Late Effects
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Causative Treatment
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Signs and Symptoms
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Screening and Diagnostic Tests
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Management and Intervention
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aAdapted from Schwartz et al.[37]
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Overt hypothyroidism (elevated TSH, decreased T4) |
Radiation: >20 Gy to the neck, cervical spine |
Hoarseness, fatigue, weight gain, dry skin, cold intolerance, dry brittle hair, alopecia, constipation, lethargy, poor linear growth, menstrual irregularities, pubertal delay, bradycardia, hypotension |
Free T4, TSH annually up to 10 years postradiation or if symptomatic, plot on growth chart |
Refer to endocrinologist, T4 replacement, anticipatory guidance regarding symptoms of hyperthyroidism/ hypothyroidism |
Radiation: >7.5 Gy TBI |
Surgery: Partial or complete thyroidectomy |
Compensated hypothyroidism (elevated TSH, normal T4) |
Same as overt hypothyroidism with regard to radiation and surgery |
Asymptomatic |
Free T4, TSH annually up to 10 years postradiation or if symptomatic, plot on growth chart |
Refer to endocrinologist, T4 to suppress gland activity |
Thyroid nodules |
Any dose radiation |
Hoarseness, fatigue, weight gain, dry skin, cold intolerance, dry brittle hair, alopecia, constipation, lethargy, poor linear growth, menstrual irregularities, pubertal delay, bradycardia, hypotension |
Free T4, TSH annually up to 10 years postradiation or if symptomatic, plot on growth chart, physical exam; ultrasound for technetium99m scan baseline and then as needed for symptoms |
Refer to endocrinologist, thyroid scan, biopsy/resection |
Hyperthyroidism decreased TSH, elevated T4 |
Same as overt hypothyroidism with regard to radiation |
Nervousness, tremors, heat intolerance, weight loss, insomnia, increased appetite, diarrhea, moist skin, tachycardia, exophthalmus, goiter |
Free T4, TSH annually up to 10 years postradiation or if symptomatic, plot on growth chart physical exam; ultrasound for technetium99m scan baseline and then as needed for symptoms, triiodothyronine (T3), antithyroglobulin, antimicrosomal antibody baseline, then as needed for symptoms |
Refer to endocrinologist, propylthiouracil (PTU), propanol 131I, thyroidectomy |
References
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Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.
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