Structural and functional changes in the thyroid gland in the early and late periods after radiation therapy

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Resumo

Background: Recently, more and more attention has been paid to the study of acute and late consequences of cancer treatment. To date, a small number of studies on thyroid dysfunction in the acute period after radiation therapy (RT) to the neck and supraclavicular lymph nodes have been published in the literature.

Objective: Assessment of the prevalence of structural and functional changes in the thyroid gland in the acute period after RT for head and neck cancer (HNC) and breast cancer (BC).

Materials and methods: The prospective study included 35 patients, median age – 46 years [41; 49]: 14 patients with HNSCC (7 men and 7 women) and 21 patients with BC. The study of the TSH, free T4, thyroglobulin levels and thyroid ultrasound were performed before the start of RT, immediately after its completion and 6 months later.

Results: In three patients (8.57%), destructive thyroiditis was detected immediately after the completion of RT – subclinical thyrotoxicosis was registered in one patient with HNSCC and in one patient with BC. Another patient with BC had a hypothyroid phase of destructive thyroiditis. In all three cases, the patients did not present any complaints, and the laboratory parameters reached the reference values during the repeat examination after 6 months. When comparing the parameters over time, a significant decrease in the thyroid gland volume was noted immediately after RT compared to the volume before RT (p=0.043). After 6 months, 2 cases of hypothyroidism (5.71%) were noted: one case of subclinical hypothyroidism after treatment for BC and one case of manifest hypothyroidism after treatment for HNC.

Conclusion: In the early period after RT, destructive thyroiditis may develop, which has no clinical manifestations and resolves spontaneously within a few months. After 6 months, the risk of hypothyroidism increases, requiring replacement therapy.

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Sobre autores

Ilya Amergulov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Autor responsável pela correspondência
Email: ilya_a94@mail.com
ORCID ID: 0000-0001-8637-1483

Postgraduate Student, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Maria Pavlova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: mgp.doc@yandex.ru
ORCID ID: 0000-0001-6073-328X

Cand. Sci. (Med.), Associate Professor at the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Yulia Sych

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: juliasytch@mail.ru
ORCID ID: 0000-0002-7000-0095

Cand. Sci. (Med.), Associate Professor at the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Yulia Zhuravleva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: zhjulia03@list.ru
ORCID ID: 0009-0007-5466-6165

5th year student of the Faculty of General Medicine

Rússia, Moscow

Magomed Dolov

Moscow International Oncology Center

Email: ilya_a94@mail.com
ORCID ID: 0009-0004-5039-7875

Radiotherapist, Department of Radiation Therapy

Rússia, Moscow

Mergen Berdyklychev

N.N. Blokhin National Medical Research Center of Oncology

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-6646-8728

Oncologist, Outpatient Department of Extra-Budgetary Medical ActivitiesOncologist, Outpatient Department of Extra-Budgetary Medical Activities

Rússia, Moscow

Valentina Dobrokhotova

I.M. Sechenov First Moscow State Medical University (Sechenov University); N.N. Blokhin National Medical Research Center of Oncology

Email: ilya_a94@mail.com
ORCID ID: 0000-0001-5889-392X

Cand. Sci. (Med.), Associate Professor at the Department of Oncology, Oncologist, Surgical Department of Head and Neck Tumors

Rússia, Moscow; Moscow

Ekaterina Sannikova

N.N. Blokhin National Medical Research Center of Oncology

Email: ilya_a94@mail.com
ORCID ID: 0009-0002-5249-3751

Medical Physicist, Department of Radiation Therapy

Rússia, Moscow

Oksana Trofimova

N.N. Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-7204-370X

Dr. Sci. (Med.), Leading Researcher, Department of Radiation Therapy, Radiotherapist, Professor at the Department of Oncology

Rússia, Moscow; Moscow

Maria Orlova

National Medical Research Radiological Center

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-8213-4461

Radiotherapist, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute

Rússia, Moscow

Daria Kuznetsova

National Medical Research Radiological Center

Email: ilya_a94@mail.com
ORCID ID: 0009-0009-1008-9583

Radiotherapist, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute 

Rússia, Moscow

Natalia Bychkova

National Medical Research Radiological Center

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-5177-2612

Cand. Sci. (Med.), Head of the Day Hospital, Division of Radiation Therapy, Radiotherapist, Herzen Moscow Oncology Research Institute 

Rússia, Moscow

Natalia Zaitseva

National Medical Research Radiological Center

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-2764-5189

Head of the Physicotechnical Department, Division of Radiation Therapy, Herzen Moscow Oncology Research Institute 

Rússia, Moscow

Elena Kandakova

Russian Research Center of Roentgenology and Radiology

Email: ilya_a94@mail.com
ORCID ID: 0000-0001-7127-7881

Dr. Sci. (Med.), Head of the 70-bed Radiation Therapy Department with a 30-bed Day Hospital of the Radiation Therapy Clinic

Rússia, Moscow

Vladimir Sotnikov

Russian Research Center of Roentgenology and Radiology

Email: ilya_a94@mail.com
ORCID ID: 0000-0003-0498-314X

Dr. Sci. (Med.), Head of the Division of MASC

Rússia, Moscow

Ekaterina Ryzhkova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: ilya_a94@mail.com
ORCID ID: 0000-0003-0069-1692

Postgraduate Student, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Valentin Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: ilya_a94@mail.com
ORCID ID: 0000-0002-3026-6315

Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Endocrinology No. 1

Rússia, Moscow

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2. Figure 1. Dynamics of thyroid-stimulating hormone levels in groups of patients taking levothyroxine during treatment and in groups of patients not taking the drugs (control)

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3. Figure 2. Dynamics of free T4 levels in groups of patients taking levothyroxine during radiation therapy and in groups of patients not taking the drugs (control)

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4. Figure 3. Dynamics of thyroglobulin levels in groups of patients taking levothyroxine during radiation therapy and in groups of patients not taking the drugs (control)

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5. Figure 4. Dynamics of thyroid gland volume in groups of patients taking levothyroxine during radiation therapy and in groups of patients not taking the drugs (control)

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6. Figure 5. Dynamics of thyroid-stimulating hormone level in patients of different groups

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7. Figure 6. Dynamics of free thyroxine level in patients of different groups

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8. Figure 7. Dynamics of thyroglobulin level in patients of different groups

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9. Figure 8. Dynamics of thyroid gland volume in patients of different groups

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