Document Detail

Diagnosis of hidden central hypothyroidism in survivors of childhood cancer.
MedLine Citation:
PMID:  10599705     Owner:  NLM     Status:  MEDLINE    
To determine how often central hypothyroidism remains undetected by routine out-patient tests of thyroid hormone, we studied 208 pediatric cancer survivors referred for evaluation because of signs of subtle hypothyroidism or hypopituitarism. Of the 208 (68 females and 140 males), 110 had brain tumors, 14 had other head/neck tumors, 11 had solid tumors remote from head and neck, and 73 had leukemia. Patients were evaluated 1-16 yr (mean, 6.1+/-4.1 yr) after tumor diagnosis. The nocturnal TSH surge and response to TRH were measured. Of 160 patients with free T4 in lowest third of normal, 34% had central hypothyroidism (blunted TSH surge or low/delayed TSH peak or delayed TSH decline after TRH); 9% had central hypothyroidism with mild TSH elevation (mixed hypothyroidism). Another 16% had mild primary hypothyroidism (TSH, 5-15 mU/L). Of 48 with free T4 in the upper two thirds of normal, 14% had central hypothyroidism; 17% had mild primary hypothyroidism. Incidence of central, mixed, and mild primary hypothyroidism 10 yr after tumor diagnosis was significantly related to total cranial radiation dose (P < 0.0001). Of 62 patients with central hypothyroidism, 34% had not developed GH deficiency. TSH surge identified 71%, and response to TRH identified 60% of those with central hypothyroidism. More than half of the slowly growing patients who have received cranial or craniospinal radiation for childhood cancer develop subtle hypothyroidism. In our study group, 92% of patients with central hypothyroidism and 27% with mixed hypothyroidism would have remained undiagnosed using baseline thyroid function tests alone. Both TSH surge and response to TRH must be evaluated to identify all of these patients.
S R Rose; R H Lustig; P Pitukcheewanont; D C Broome; G A Burghen; H Li; M M Hudson; L E Kun; R L Heideman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  84     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-01-07     Completed Date:  2000-01-07     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  4472-9     Citation Subset:  AIM; IM    
University of Tennessee, St. Jude Children's Research Hospital, and Methodist LeBonheur Children's Medical Center, Memphis 38103, USA.
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MeSH Terms
Brain Neoplasms / complications,  radiotherapy
Child, Preschool
Head and Neck Neoplasms / complications,  radiotherapy
Hypothyroidism / diagnosis*,  etiology
Leukemia / complications,  therapy
Neoplasms / complications*,  radiotherapy
Radiotherapy / adverse effects
Thyrotropin / blood
Thyrotropin-Releasing Hormone / diagnostic use
Thyroxine / blood
Grant Support
CA-21765-21/CA/NCI NIH HHS; M01-RR-00211/RR/NCRR NIH HHS
Reg. No./Substance:
24305-27-9/Thyrotropin-Releasing Hormone; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin

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