° | BNL 20004 { Continuing Medical Education Radiation in Childhood and Thyroid Carcinoma The association of thyroid malignancy with irradiation of the thymus and other structures in the neck area has been known for at least a quarter of a century, ‘' Reeent publications suggest a continuing incidence of such malignan- cies despite the discontinuance of lr- ib radiation for benign conditions for many years. In fact, the authors of these artieles suggest an increasing prevalence of thyroid carcinoma with time in the exyosed population. In 100 unselected patients, fifleen patients were operated upon and seven carcinomas were found. At the Michael Reese Hospital in Chi- cago, 1452 individuals with a history of prior irradiation to the neck region for benign conditions, 18-35 years affo, were Jevatuated by history, physical examination and thyroid scintigraphy. Twen- ty-one percent (301) of the group had abnormalities on examination. Of these, 56 were found only on scintigraphy. One hundred and nincty-three were opcrated upon and 56 malignancics were found. -This represented 29% of those operated upon, 18.6% of those with detectable abnormalities and 3.7% of the entire group. Four of 22 glands normal ination Prophylactic treatment with thyroid extract or l-thyroxin does not appear warranted on a routine basis. There is no evidence that this will prevent the occurrence of thyroid carcinoma. While these malignancies are not, for the most part especially aggressive, they do require treatment. They will probably represent a continuing prob- lem for many years to come. A concensus concerning management of this problem docs not exist at this time but careful observation of the population at risk may help in evolving a logical plan of treatment in the future. Harold L. Atkins, M.D. program. This has resulted in many in- quiries to physicians for guidance concerning managementof this situation in- the population at risk. % thyroid image it should be reneated with radio. lodine, preferably iodinc-123. Individuals with non-functioning nodulesshould be carcfully selected for surzery. In the Michacl Reese Hospital series the incidence of malignancy in glands With a single nodule and with multiple nodules was the same. . Public awareness of this problem has been heightened by a recent television be followed by annual physical exam- Repeated nodules are noted on the pericchnetate to palpation but with abnormal scintigraphy were positive for malignancy. The question of what to do for these individuals is not easily resolved. Cer- © tainly each person should reccive a thorough physical examination and then thereafter. scintigraphy docs not appeur to he a practical approach but perhaps a haseline study with technetium-95m pericchnetate would be of value, If functioning 1. Duffy BJ, Fitzeernid P J. Cancer of the thyroie 2. DeGroot L, Paloyan ©. Thyroid carcinomn and rodiation J.A.MLA, 225: 487-491, 1972. in chilkiren: A report of 28 cases. J. Ciln. Endoerinol Metab. 10: 1296-1308, 1959. ‘37° Nefetoff S, Harrison J, Karanfilski 3 7 et al. Continuing occurrence of thyroid carcinoma alter Itradiation to the neck In Infancy and ehnildhood. N. Eng, J. Med. 292; 171-175, 1954. . 4. Arnold J. Pinsky 3, Ryo U Y¥ ct al. Te-Som acre technetate thyroid scintigraphy In paticnts predisposed to thyroid neoplasms by pricr radios ae to the head press). and neck. Radiology (if . BULLETIN Page 3 Ss ee SRE SP ee