A prospective study of hyperparathyroidism in individuals exposed to radiation in childhood

Article Abstract:

Benign diseases of the head and neck were often treated with radiation in the 1930s and 1950s, an approach now believed to be associated with head, neck, and breast tumors appearing many years later. The parathyroid glands (located in the neck) may also be affected by these treatments. To learn more about this issue, a large group (2,923 people) of patients who received radiation treatment during childhood for benign conditions was evaluated. The group is part of an initial cohort of 4,297 people who have been followed since 1974. The subjects were questioned regarding any tumor or hospitalization history, and answers consistent with hyperparathyroidism (overactivity of the parathyroid glands) led to a further examination of the patients' medical records. The parathyroid glands produce parathyroid hormone (PTH), which increases circulating levels of calcium by stepping up its release from bone. For study purposes, 'hyperparathyroidism' was defined as hypercalcemia (elevated blood calcium levels) and elevated PTH, or hypercalcemia with the surgical removal of one or more enlarged parathyroid glands. The expected incidence of hyperparathyroidism for the population of Rochester, Minnesota was calculated, and compared with the incidence within the study population. Results showed that 32 patients had developed hyperparathyroidism, for an incidence of 18.7 per 100,000 person-years for people under the age of 40. For patients between 40 and 60, the incidence was 171 per 100,000 person-years. For both groups, this rate of occurrence was significantly higher compared with the general population. In addition, the 32 patients had developed 10 thyroid cancers (31 percent), compared with 323 thyroid cancers diagnosed in the remaining 2,885 patients (11.2 percent). This is the first prospective study reported of the effects of early radiation on the parathyroid glands, and the results indicate that people who received such treatments should undergo regular evaluation of blood calcium levels and related indexes of parathyroid function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Physiological aspects, Radiation, Radiation injuries, Neck, Hyperparathyroidism, Head, Tumors, Radiation-induced, Radiation carcinogenesis, Thyroid cancer

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Recurrence of thyroid nodules after surgical removal in patients irradiated in childhood for benign conditions

Article Abstract:

Children who received radiation therapy of the head and neck for non-thyroid related conditions have been noted to later develop thyroid nodules which are surgically removed by partial thyroidectomy. Treatment with thyroid hormone may then be given as a prophylactic (preventive) measure to prevent the recurrence of post-radiation thyroid nodules. To assess the incidence and risk factors associated with thyroid nodule recurrence 511 patients who were followed from one year to 40 years were studied. The total frequency of thyroid nodule recurrence in the study population was 19.5 percent. Among the 300 patients who were treated with thyroid hormone, at their physician's discretion, 8.4 percent developed a recurrence, compared to 35.8 percent of the 200 patients who were not given thyroid hormone prophylaxis. Radiation-associated benign thyroid nodule recurrence is high, similar to that reported for nonirradiated patients who also have a history of surgically removed thyroid nodules. Thyroid hormone treatment was clearly associated with lower rates of recurrence in all the subsets studied, most strikingly in women. No effect of thyroid hormone prophylaxis was detected in those cases in which recurrent thyroid nodules were found to be malignant (cancerous).

Health aspects, Thyroid hormones, Thyroid gland, Thyroidectomy

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Treatment of benign nodular thyroid disease

Article Abstract:

Several treatments are available for benign nodular thyroid disease. Nodules are small swellings in the gland and fine-needle aspiration biopsy reveals that only 5% are malignant. If the patient's thyroid hormone level is normal, no treatment may be needed because some nodules shrink or disappear spontaneously. However, surgery may be preferred for cosmetic reasons. Thyroxine treatment may not be beneficial. Treatment is definitely required if the patient's thyroid hormone levels are excessive. Radioiodine is usually given, but surgery is also an option.

Care and treatment, Goiter, Thyroid diseases

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