Thyroid nodules after high-dose external radiotherapy. Fine-needle aspiration cytology in diagnosis and management

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Abstract
From 1974 to 1980, studies were made of 6 patients, 5 treated for Hodgkin''s disease and 1 for a hemangioma, in whom thyroid nodules developed after high-dose (2500-4000 rad) thyroid radiation. Fine-needle aspiration cytology of the thyroid in 5 cases showed moderate to severe cellular atypia in 4 (3 of whom had elevated serum thyrotropin levels) and mild atypia in 1 (who was overtly hypothyroid). In the 4 with marked atypia, surgical pathology disclosed Hashimoto''s thyroiditis in 1, diffuse hyperplasia and epithelial atypia in 2 and a sclerosing papillary carcinoma in 1. Among 5 patients who had total thyroidectomy, 3 had carcinoma (microscopic papillary, papillary-follicular, or sclerosing papillary) in addition to one or more follicular adenomas or colloid nodules. Thyroid nodules and neoplasia may be more common than previously appreciated in patients exposed to high-dose radiation.