HYPOTHYROIDISM AND GRAVES' DISEASE AFTER MANTLE IRRADIATION: A FOLLOW UP STUDY

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Abstract
Fifty of 66 patients whose thyroid function had previously been assessed 7-139 months after irradiation for Hodgkin''s disease were re-evaluated 35 .+-. 3 months later. They could be divided into three groups: those whose thyroid function had been normal in the first study (N = 26), those who had asymptomatic impaired thyroid reserve (N = 19), and those in whom evidence of Graves'' disease had developed (N = 5). The 26 patients who had been euthyroid when first studied had developed significant increases in mean thyroid-stimulating hormone (TSH) levels (basal and following thyrotrophin releasing hormone) without changes in mean free thyroxine index (FTI). In three of these patients, each studied within six years of irradiation, basal TSH had risen to hypothyroid levels. There were no significant changes in mean FTI or basal and peak TSH in 19 patients who had demonstrated impaired thyroid reserve in the first study. The cumulative incidence of impaired thyroid reserve in the total cohort is now 30/66 (45%) but only one of these 30 has developed clinical hypothyroidism. Five patients developed evidence of Graves'' disease. Two patients with thyrotoxicosis and one with euthyroid Graves'' disease were found in the initial study. On re-evaluation, a third patient had developed frank thyrotoxicosis and another euthyroid Graves'' disease, giving a cumulative incidence of Graves'' disease of 5/66 (7%). Three of these five were HLA-DR3 and three had measurable thyrotrophin binding inhibiting immunoglobulins. We conclude that impaired thyroid reserve continues to develop within six years of mantle irradiaton in adults but once established appears to remain stable. There also appears to be a high incidence of Graves'' disease after mantle irradiation.