Clinical and Translational Oncology

, Volume 20, Issue 11, pp 1430–1438 | Cite as

Evaluation of thyroid gland as an organ at risk after breast cancer radiotherapy: a systematic review and meta-analysis

  • L. Darvish
  • M. Ghorbani
  • S. Hosseini Teshnizi
  • N. Roozbeh
  • F. Seif
  • M. Reza Bayatiani
  • C. Knaup
  • A. AmraeeEmail author
Research Article



Radiotherapy can often lead to thyroid dysfunction. Some studies demonstrated that treatment of breast cancer by RT can expose thyroid gland to high doses of radiation. The aim of this systematic review is to evaluate consideration of thyroid gland as an organ at risk.


In this systematic review and meta-analysis to select initial studies, a comprehensive search by two independent reviewers was performed. Electronical databases following: Web of Science, Google Scholar, Scopus, PubMed, Elsevier, Embase, ProQuest and Persian databases such as Iranmedex, Magiran, and SID were searched. All searches were restricted to English language between 1985 and 2017. A random effect meta-analysis is applied to estimate pooled effect size across initial studies. Funnel plot with Egger’s test is used to assess potential publication bias.


Totally, five studies (478 samples) were included in meta-analysis. The meta-analyses of result showed that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy (z = 2.68, P = 0.007). The pooled estimate of difference mean for TSH was 0.90 (95% CI 0.24, 1.55). In studies among patients with breast cancer RT, hypothyroidism was reported more than other thyroid disorders. There was not showed possibility publication bias among studies (P > 0.05).


This study demonstrated that thyroid gland is affected by radiotherapy significantly and the TSH increased after radiotherapy. Protecting thyroid gland during radiation and follow-up of patients with breast cancer RT are suggested for the assessment of thyroid gland dysfunction.


Thyroid dysfunction Breast cancer Radiotherapy Organ at risk 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval (research involving human participants and/or animals)

This work has not any human or animal participants.

Informed consent

There is no consent for this work.


  1. 1.
    Kuijpens JL, Nyklíctek I, Louwman MW, Weetman TA, Pop VJ, Coebergh JW. Hypothyroidism might be related to breast cancer in post-menopausal women. Thyroid. 2005;15(11):1253–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Ferlay J, Héry C, Autier P, Sankaranarayanan R. Global Burden of Breast Cancer. Breast Cancer Epidemiol. 2009. Scholar
  3. 3.
    Dorri Giv M, Bahreini Toosi MH, Aghamiri SMR, Akbari F, Taeb S. Calculation of thyroid dose with planner system and evaluation of thyroid function after radiotherapy for patients with breast cancer. J Biomed Phys Eng. 2016;6(4):229–34.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Cardoso LJSF, Martine J, Piccart–William C, Wood–Chie-Mien H. Breast cancer and molecular medicine. Switzerland: Springer; 2006.Google Scholar
  5. 5.
    Weinberg RA, Hahn WC, Watnick R, Stewart S, Mani SA, Yang J. Rules governing the creation of human tumor cells. Int J Cancer. 2002;100(S13):1.CrossRefGoogle Scholar
  6. 6.
    Early Breast Cancer Trialists’ Collaborative Group. (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.CrossRefGoogle Scholar
  7. 7.
    Seyed Yousuf Ali, Gurcharan Singh. Radiation induced Alopecia. Int J Trichol. 2010; 2(2):118–119CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bucci M, Bevan A, Roach M. Advances in radiation therapy: conventional to 3D, to IMRT, to 4D, and beyond. CA Cancer J Clin. 2005;55(2):117–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Tunio MA, Al Asiri M, Bayoumi Y, Stanciu LG, Al Johani N, Al Saeed EF. Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study. J Cancer Res Ther. 2015;11(4):684–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Hancock SL, McDougall IR, Constine LS. Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol Biol Phys. 1995;31(5):1165–70.CrossRefPubMedGoogle Scholar
  11. 11.
    Bassiri RM, Utiger RD. Thyrotropin-releasing hormone in the hypothalamus of the rat. Endocrinology. 1974;94(1):188–97.CrossRefPubMedGoogle Scholar
  12. 12.
    Beck-Peccoz Paolo, Amr Sania. M. Margarida Menezes-Ferreira, Giovanni Faglia, and Bruce D. Weintraub. Decreased receptor binding of biologically inactive thyrotropin in central hypothyroidism. Effect of treatment with thyrotropin-releasing hormone. N Engl J Med. 1985;312:1085–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Jereczek-Fossa B, Alterio D, Jassem J, Tradati N, Orecchia R. Radiotherapy-induced thyroid disorders. Cancer Treat Rev. 2004;30(4):369–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Roozbeh N, Azizi M, Darvish L. Pregnancy outcome of abnormal nuchal translucency: a systematic review. J of Clin and Diag Res. 2017;11(3):12–6.Google Scholar
  15. 15.
    Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Roozbeh N, Nahidi F, Hajiyan S. Barriers related to prenatal care utilization among women. Saudi Med J. 2016;37(12):13–1319.CrossRefGoogle Scholar
  17. 17.
    Joensuu H, Viikari J. Thyroid function after postoperative radiation therapy in patients with breast cancer. Acta Radiol Oncol. 1986;25(3):167–70.CrossRefPubMedGoogle Scholar
  18. 18.
    Bruning P, Bonfrèr J, De Jong-Bakker M, Nooyen W, Burgers M. Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph node. Br J Cancer. 1985;51(5):659–63.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Reinertsen KV, Cvancarova M, Wist E, Bjøro T, Dahl AA, Danielsen T et al. Thyroid Function in Women after Multimodal Treatment for Breast Cancer Stage II/III: Comparison With Controls From a Population Sample. Int J Radiat Oncol Biol Phys. 2009: 75(3):764–70.CrossRefGoogle Scholar
  20. 20.
    Akureki S, Ibrahim Babalioglu I, Kose K, Saban C. GOKCE. Thyroid dysfunction following supraclavicular irradiation in the management of carcinoma of the breast. Int J of Hema Oncol 2014; 24(2):139–144.Google Scholar
  21. 21.
    Johansen S, Reinertsen KV, Knutstad K, Olsen DR, Fosså SD. Dose distribution in the thyroid gland following radiation therapy of breast cancer—a retrospective study. Radiat Oncol. 2011;6:68.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Smith GL, Smith BD, Giordano SH, Shih YC, Woodward WA, Strom EA, et al. Risk of hypothyroidism in older breast cancer patients treated with radiation. Cancer. 2008;112(6):1371–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Wolny-Rokicka E, Tukiendorf A, Wydmański J, Roszkowska D, Staniul BS, Zembroń-Łacny A. Thyroid function after postoperative radiation therapy in patients with breast cancer. Asian Pac J Cancer Prev. 2016;17(10):4577–81.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Kim SS, Kim SJ, Bae YT, Lee JY, Kim BH, Kim YK, et al. Factors associated with the development of new onset diffuse thyroid F18-Fluorodeoxyglucose uptake after treatment of breast cancer in patients without a history of thyroid disease or thyroid dysfunction. Thyroid Radiol Nucl Med. 2012;22(1):53–8.Google Scholar
  25. 25.
    Srikantia N, Rishi K, Janaki MG, Bilimagga R, Ponni A, Rajeev AG, et al. How common is hypothyroidism after external radiotherapy to neck in head and neck cancer patients. J Cancer Res Ther. 2011;32(3):143–8.Google Scholar
  26. 26.
    Tell R, Lundell G, Nilsson B, Sjödin H, Lewin F. Rolf Lewensohn. Int J of Radiol Oncol Bio Phys. 2004;60(2):395–400.CrossRefGoogle Scholar
  27. 27.
    Garcia-Serra A, Amdur RJ, Morris CG, Ernest M, William M. William Thyroid Function Should Be Monitored Following Radiotherapy to the Low Neck. Am J Clin Oncol. 2011;28(3):255–8.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Mother and Child Welfare Research CenterHormozgan University of Medical SciencesBandar AbbasIran
  2. 2.Biomedical Engineering and Medical Physics Department, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Biostatistics, Medical SchoolShiraz University of Medical SciencesShirazIran
  4. 4.Department of Radiotherapy and Medical Physics, Faculty of Para medicineArak University of Medical Sciences and Khansari HospitalArakIran
  5. 5.Comprehensive Cancer Centers of NevadaLas VegasUSA
  6. 6.Department of Medical Physics, Faculty of MedicineSchool of Medicine, Iran University of Medical SciencesTehranIran

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