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Journal of Endocrinological Investigation

, Volume 33, Issue 3, pp 135–139 | Cite as

Thyroid function and thyroid autoimmunity in childhood acute lymphoblastic leukemia off-therapy patients treated only with chemotherapy

  • M. Delvecchio
  • V. Cecinati
  • L. P. Brescia
  • M. F. Faienza
  • D. De Mattia
  • L. Cavallo
  • N. Santoro
Original Article

Abstract

Objective: Scanty data are available about the thyroid function in childhood acute lymphoblastic leukemia (ALL) off-therapy patients treated only with chemotherapy. We aimed to assess the prevalence of thyroid autoimmunity and thyroid dysfunction in such patients. Design: Case-control cross-sectional study. Methods: Eighty-four patients diagnosed with ALL and treated only with chemotherapy. Mean age at diagnosis 5.9±3.6 yr, at recruitment 12.1±4.3 yr. The treatment had been stopped 4.3±3.2 yr before recruitment. A control group of 60 subjects was recruited. Free T4, TSH, anti-thyroperoxidase, and anti-thyroglobulin antibodies were measured. Results: Anti-thyroglobulin and anti-thyroperoxidase antibodies were negative in all patients. TSH was increased in 7 patients (8.3%) and 3 controls (5.0%). Free T4 was within the normal limits in all patients and controls. Mean TSH and free T4 levels did not statistically differ between controls and ALL off-therapy patients. TSH was negatively correlated with the age at the diagnosis (p=0.01) and the age at the end of therapy (p=0.008). Anti-thyroglobulin and/or anti-thyroperoxidase antibodies were detected in 3 controls (5%; vs study group: p=0.038), 1 of them with increased TSH. Conclusions: Some patients present hyperthyrotropinemia, without anti-thyroid antibodies, with a prevalence comparable to the control group. The thyroid gland seems more prone to be damaged by chemotherapy at a younger age. We think that a thyroid follow-up in ALL off-therapy patients may be advisable and should be differentiated on the basis of the age at the end of treatment, with more frequent tests for younger patients.

Keywords

Chemotherapy childhood acute lymphoblastic leukaemia thyroid autoimmunity thyroid function 

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References

  1. 1.
    Friedman DL, Meadows AT. Late effects of childhood cancer therapy. Pediatr Clin North Am 2002, 49: 1083–106, x.PubMedCrossRefGoogle Scholar
  2. 2.
    Oeffinger KC, Mertens AC, Sklar CA, et al; Childhood Cancer Survivor Study. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006, 355: 1572–82.PubMedCrossRefGoogle Scholar
  3. 3.
    van Santen HM, Vulsma T, Dijkgraaf MG, et al. No damaging effect of chemotherapy in addition to radiotherapy on the thyroid axis in young adult survivors of childhood cancer. J Clin Endocrinol Metab 2003, 88: 3657–63.PubMedCrossRefGoogle Scholar
  4. 4.
    Stevens G, Downes S, Ralston A. Thyroid dose in children undergoing prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys 1998, 42: 385–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Atahan IL, Yildiz F, Ozyar E, Uzal D. Thyroid dysfunction in children receiving neck irradiation for Hodgkin’s disease. Radiat Med 1998, 16: 359–61.PubMedGoogle Scholar
  6. 6.
    Nishiyama K, Kozuka T, Higashihara T, Miyauchi K, Okagawa K. Acute radiation thyroiditis. Int J Radiat Oncol Biol Phys 1996, 36: 1221–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Hancock SL, McDougall IR, Constine LS. Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol Biol Phys 1995, 31: 1165–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Healy JC, Shafford EA, Reznek RH, et al. Sonographic abnormalities of the thyroid gland following radiotherapy in survivors of childhood Hodgkin’s disease. Br J Radiol 1996, 69: 617–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Mohn A, Chiarelli F, Di Marzio A, Impicciatore P, Marsico S, Angrilli F. Thyroid function in children treated for acute lymphoblastic leukemia. J Endocrinol Invest 1997, 20: 215–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Ogilvy-Stuart AL, Clark DJ, Wallace WH, et al. Endocrine deficit after fractionated total body irradiation. Arch Dis Child 1992, 67: 1107–10.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Katsanis E, Shapiro RS, Robison LL, et al. Thyroid dysfunction following bone marrow transplantation: long-term follow-up of 80 pediatric patients. Bone Marrow Transplant 1990, 5: 335–40.PubMedGoogle Scholar
  12. 12.
    Borgström B, Bolme P. Thyroid function in children after allogeneic bone marrow transplantation. Bone Marrow Transplant 1994, 13: 59–64.PubMedGoogle Scholar
  13. 13.
    Socié G, Curtis RE, Deeg HJ, et al. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia. J Clin Oncol 2000, 18: 348–57.PubMedGoogle Scholar
  14. 14.
    Nygaard R, Bjerve KS, Kolmannskog S, Moe PJ, Wesenberg F. Thyroid function in children after cytostatic treatment for acute leukemia. Pediatr Hematol Oncol 1988, 5: 35–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Madanat LM, Lahteenmaki PM, Alin J, Salmi TT. The natural history of thyroid function abnormalities after treatment for childhood cancer. Eur J Cancer 2007, 43: 1161–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Madanat LM, Lahteenmaki PM, Hurme S, Dyba T, Salmi TT, Sankila R. Hypothyroidism among pediatric cancer patients: a nationwide, registry-based study. Int J Cancer 2008, 122: 1868–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Ansaldi N, Palmas T, Corrias A, et al. Autoimmune thyroid disease and celiac disease in children. J Pediatr Gastroenterol Nutr 2003, 37: 63–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Loviselli A, Velluzzi F, Mossa P, et al; Sardinian Schoolchildren Study Group. The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinian schoolchildren: relationship to goiter prevalence and thyroid function. Thyroid 2001, 11: 849–57.PubMedCrossRefGoogle Scholar
  19. 19.
    Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002, 87: 489–99.PubMedCrossRefGoogle Scholar
  20. 20.
    Milakovic M, Berg G, Eggertsen R, Lindstedt G, Nyström E. Screening for thyroid disease of 15–17-year-old schoolchildren in an area with normal iodine intake. J Intern Med 2001, 250: 208–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Kabelitz M, Liesenkotter KP, Stach B, et al. The prevalence of anti-thyroid peroxidase antibodies and autoimmune thyroiditis in children and adolescents in an iodine replete area. Eur J Endocrinol 2003, 148: 301–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Kosmidis S, Baka M, Bouhoutsou D, et al. Longitudinal assessment of immunological status and rate of immune recovery following treatment in children with ALL. Pediatr Blood Cancer 2008, 50: 528–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Krupica T Jr, Fry TJ, Mackall CL. Autoimmunity during lymphopenia: a two-hit model. Clin Immunol 2006, 120: 121–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Oberfield SE, Allen JC, Pollack J, New MI, Levine LS. Long-term endocrine sequelae after treatment of medulloblastoma: prospective study of growth and thyroid function. J Pediatr 1986, 108: 219–23.PubMedCrossRefGoogle Scholar
  25. 25.
    Livesey EA, Brook CG. Thyroid dysfunction after radiotherapy and chemotherapy of brain tumours. Arch Dis Child 1989,64: 593–5.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Ogilvy-Stuart AL, Shalet SM, Gattamaneni HR. Thyroid function after treatment of brain tumors in children. J Pediatr 1991, 119: 733–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Schmiegelow M, Feldt-Rasmussen U, Rasmussen AK, Lange M, Poulsen HS, Müller J. Assessment of the hypothalamo-pituitary-adrenal axis in patients treated with radiotherapy and chemotherapy for childhood brain tumor. J Clin Endocrinol Metab 2003, 88: 3149–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Sutcliffe SB, Chapman R, Wrigley PF. Cyclical combination chemotherapy and thyroid function in patients with advanced Hodgkin’s disease. Med Pediatr Oncol 1981, 9: 439–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Stuart NS, Woodroffe CM, Grundy R, Cullen MH. Long-term toxicity of chemotherapy for testicular cancer—the cost of cure. Br J Cancer 1990, 61: 479–84.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Arrigo T, Wasniewska M, Crisafulli G, et al. Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 2008, 31: 79–84.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2010

Authors and Affiliations

  • M. Delvecchio
    • 1
  • V. Cecinati
    • 1
  • L. P. Brescia
    • 1
  • M. F. Faienza
    • 1
  • D. De Mattia
    • 1
  • L. Cavallo
    • 1
  • N. Santoro
    • 1
  1. 1.Department of Biomedicine of Developing AgeUniversity of BariBariItaly

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