Thyroid Abnormalities After Radiation Exposure in Infancy

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Abstract
The relationship of thyroid cancer in children and young adults to antecedent X-irradiation of the neck in infancy was well established by epidemiologic studies. As part of a prospective study of thymus-irradiated children, 105 patients in a high-risk group (treated with anterior and posterior ports, usually with more than 300 R in air) were examined for thyroid abnormality. Twenty-three% of the irradiated patients (average age: 26 years) had palpably nodular glands and 2 had diffuse enlargement. Of these, approximately 1/2 had solitary nodules, and the remainder multiple nodules. The incidence of nodularity in females was 2.4 times that in males. Four of 5 glands clinically suspicious of carcinoma were removed but proved on histologic examination to be benign lesions of a variety of types, including adenomatous and hyperplastic change. Even those lesions which presented clinically as solitary nodules proved to be multicentric on pathologic study. Functional tests (PBI [protein bound iodine], RAI [radioactive iodine] uptake) were normal in all cases. In 113 controls (age and sex matched), only 2 nodules and 4 diffusely enlarged glands were detected. Irradiation of the thyroid gland in infancy causes permanent injury leading to the formation of nodular goiters in a high proportion of cases.