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BNL 20004
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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
.
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