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September 22, 1978, Vol 240, No. 13 >
ARTICLE | September 22, 1978

Graves' Disease Following Irradiation for Hodgkin's Disease FREE

Miljenko V. Pilepich, MD; Ivor Jackson, MD; John E. Munzenrider, MD; Rosalind S. Brown, MD
[+] Author Affiliations

Reprints not available.


JAMA. 1978;240(13):1381-1382. doi:10.1001/jama.1978.03290130075030
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References

THE THYROID gland is commonly included in the radiation field in patients with Hodgkin's disease treated with radiation therapy. The so-called mantle field routinely includes the neck. A substantial number of patients with non-Hodgkin's lymphoma, head and neck tumors, and breast carcinoma also receive neck irradiation.

The thyroid was traditionally considered a radioresistant organ. However, several reports on thyroid dysfunction following neck irradiation have appeared in recent years. Glatstein et al1 reported a 44% incidence of elevated serum thyroid-stimulating hormone (TSH) concentration in patients with lymphomas who had lymphangiography and received neck irradiation. In 11% of these patients, clinical hypothyroidism or evidence of thyroid hypofunction (according to laboratory tests other than serum TSH determination) developed. Although the exact incidence and pathogenesis are not known, hypothyroidism is a recognized complication of thyroid irradiation.

Graves' disease following thyroid irradiation, manifested either as hyperthyroidism or ophthalmopathy, is not a well-recognized entity.

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REFERENCES

1 +
Glatstein E, McHardy-Young S, Brast N, et al:  Alterations in serum thyrotropin (TSH) and thyroid function following radiotherapy in patients with malignant lymphoma . J Clin Endocrinol Metab 32:833-841, 1971;.
2 +
Calder AE, Irvine WJ:  Cell-mediated immunity and immune complexes in thyroid disease . Clin Endocrinol Metabol 4:287-318, 1975;.
3 +
Knox AJS, von Westarp C, Row VV, et al:  Thyroid antigen stimulates lymphocytes from patients with Graves' disease to produce thyroid-stimulating immunoglobulin (TSI) . J Clin Endocrinol Metab 43:330-337, 1976;.
4 +
McKenzie JM, Zakarija M:  A reconsideration of a thyroid-stimulating immunoglobulin as the cause of hyperthyroidism in Graves' disease . J Clin Endocrinol Metab 42:778-781, 1976;.
5 +
Mori T, Kriss JP:  Measurements by competitive bonding radioassay of serum anti-microsomal and anti-thyroglobulin antibodies in Graves' disease and other thyroid disorders . J Clin Endocrinol Metab 33:688-698, 1971;.
6 +
Mahieu P, Winand R:  Demonstration of delayed hypersensitivity to retrobulbar and thyroid tissues in human exophthalmus . J Clin Endocrinol Metab 34:1090-1092, 1972;.
7 +
Wasnich RD, Grumet FC, Payne RO, et al:  Graves' ophthalmopathy following external neck irradiation for nonthyroidal neoplastic disease . J Clin Endocrinol Metab 37:703-713, 1973;.

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1 +
Glatstein E, McHardy-Young S, Brast N, et al:  Alterations in serum thyrotropin (TSH) and thyroid function following radiotherapy in patients with malignant lymphoma . J Clin Endocrinol Metab 32:833-841, 1971;.
2 +
Calder AE, Irvine WJ:  Cell-mediated immunity and immune complexes in thyroid disease . Clin Endocrinol Metabol 4:287-318, 1975;.
3 +
Knox AJS, von Westarp C, Row VV, et al:  Thyroid antigen stimulates lymphocytes from patients with Graves' disease to produce thyroid-stimulating immunoglobulin (TSI) . J Clin Endocrinol Metab 43:330-337, 1976;.
4 +
McKenzie JM, Zakarija M:  A reconsideration of a thyroid-stimulating immunoglobulin as the cause of hyperthyroidism in Graves' disease . J Clin Endocrinol Metab 42:778-781, 1976;.
5 +
Mori T, Kriss JP:  Measurements by competitive bonding radioassay of serum anti-microsomal and anti-thyroglobulin antibodies in Graves' disease and other thyroid disorders . J Clin Endocrinol Metab 33:688-698, 1971;.
6 +
Mahieu P, Winand R:  Demonstration of delayed hypersensitivity to retrobulbar and thyroid tissues in human exophthalmus . J Clin Endocrinol Metab 34:1090-1092, 1972;.
7 +
Wasnich RD, Grumet FC, Payne RO, et al:  Graves' ophthalmopathy following external neck irradiation for nonthyroidal neoplastic disease . J Clin Endocrinol Metab 37:703-713, 1973;.

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