401 THYROID FUNCTION IN CHILDREN TREATED FOR HODGKINS DISEASE (HD)

Abstract

Thyroid function in 29 children with HD was followed a minimum of 24 months following diagnosis. Age of the patients (pts.) ranged from 4-16 yrs. (median=13 yrs.). 26/29 pts. had lymphangiography. 5/29 received only combination chemotherapy. 24/29 received 2800 to 5000 rads of radiation to the mantle, mediastinum or neck. 10/24 had combination chemotherapy subsequent to irradiation. T₄ RIA, TSH, T₃ uptake were measured at regular intervals. 0/5 pts. treated with only chemotherapy demonstrated any abnormal thyroid function. 14/24 pts. receiving radiation subsequently had elevated TSH (TSH>6.0 uU/ml) and low T₄ index (T₄ index <5.0). 8/24 had normal T₄ index but elevated TSH (range 8.8 to 22, median=14 uU/ml), 2/24 had normal TSH and T₄ index. 11/14 children with abnormal TSH and T₄ index were treated with thyroid replacement. 3/14 with abnormal T₄ index and TSH were not treated; two returned to normal 49 and 55 mo. after radiation. Of the 8 pts. with normal T₄ index but abnormal TSH 1 was treated with thyroid replacement and 7/8 were not treated. TSH returned to normal in 3 untreated pts. 32 to 88 mos. after radiation. One pt. was clinically hyperthyroid with elevated T4 (23.6 mcg/dl) 6 mo. after radiation but eventually developed severe hypothyroidism (T4=0.3 mcg/dl and TSH=202 uU/ml). 92% of children in our series developed evidence of thyroid dysfunction following radiation therapy for HD. All children with HD treated in such a manner should have thyroid function monitored closely.

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