Thyroid Cancer Occurring as a Late Consequence of Head-and-Neck Irradiation

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Abstract
From January 1 to September 30, 1974, we examined 1056 of 5266 subjects (20.1 per cent) who had received therapeutic irradiation primarily for infections and inflammatory disease of the upper respiratory tract at our institution during the 1940's and 1950's. The tonsillar and nasopharyngeal region was the treatment site in 85 per cent of those examined. Palpable nodular thyroid disease was found in 16.5 per cent, and nonpalpable lesions were detected by 99mTc pertechnetate thyroid imaging in an additional 10.7 per cent, for a prevalence of nodular disease of 27.2 per cent. Operation on 71 per cent with nodular disease revealed thyroid cancer in 33 per cent (60 of 182). Preliminary analysis for potential risk factors suggests a correlation between radiation exposure and the presence of thyroid nodules (P<0.001). These findings indicate that nodular thyroid disease, both benign and malignant, continues as a major health problem for at least 35 years in exposed subjects. (N Engl J Med 294:1019–1025, 1976)