SERUM THYROGLOBULIN AFTER MANTLE IRRADIATION FOR HODGKIN'S DISEASE

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Abstract
Thyroid function and serum thyroglobulin levels were studied in 66 patients whose Hodgkin''s disease had been previously treated by cervical, mediastinal and axillary lymph node (mantle) irradiation. Three patients were already undergoing treatment for thyroid disorders (1 for primary hypothyroidism, 2 for Graves'' disease); a 4th was found to have euthyroid Graves'' disease. Thirty-six (Group I) of the remaining 62 patients had normal free thyroxin indices, normal basal TSH levels and normal TSH response to TRH. In 20 patients (Group II) free thyroxin indices were normal, but either basal TSH levels were raised or normal basal TSH levels were associated with an exaggerated response to TRH. In 6 patients (Group III) free thyroxin indices were subnormal. Although results of thyroid function tests in group I lay within the normal range, the mean free thyroxine index was significantly lower and mean basal and peak TSH levels were significantly higher than those of a group of 35 normal subjects, indicating mild thyroid hypofunction. Elevated thyroglobulin levels were demonstrated in 11 irradiated subjects (18%). Mean thyroglobulin levels were significantly raised in each of the 3 groups of irradiated subjects. Significant positive correlations were found between log serum thyroglobulin and log basal TSH (r = 0.453, P < 0.001) and log peak TSH (r = 0.515, P < 0.001) levels. Mild thyroid hypofunction is common after mantle irradiation for Hodgkin''s disease; raised serum thyroglobulin levels are a sensitive indicator of TSH stimulation of the damaged thyroid gland.

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