ORIGINAL ARTICLES   

Minerva Pediatrica 2006 October;58(5):469-76

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Treatment for acute lymphoblastic leukemia in children is associated with papillary carcinoma of thyroid, but not with thyroid disfunction

Neves Mascarenhas A. ¹, Papadia C. ^{2, 3}, Alves Aquino C. ⁴, Oba L. ^{2, 3}, Ferreira M. ⁵, Casulari L. A. ^{2, 3}

¹ Endocrinology Service Hospital Regional da Asa Norte, Brasília, Brazil 2 Neurosurgery Unit Hospital de Base do Distrito Federal University of Brasília, Brasilia, Brazil 3 Endocrinology Service University of Brasilia, Brasilia, Brasil 4 Radiology Service Hospital Universitário Onofre Lopes Natal, RN, Brazil 5 Hormone Laboratory Hospital de Base do Distrito Federal Brasilia, Brazil

Aim. The treatment of acute lymphoblastic leukemia (ALL) in children may cause sequelae, some appearing only at long-term follow-up. We investigated the thyroid gland morphology and the function of the pituitary-thyroid axis in a group of patients treated for ALL in childhood.
Methods. A cohort study was conducted at a tertiary medical center. Thirty-three children (22 males and 11 females; age: 11.9±3 years; range: 6 to 18 years) were studied. The mean age at the time of chemotherapy and prophylactic cranial irradiation (12-24 Gy) was 5.5±2.6 years (range: 1 to 14 years). The average length of the follow-up was 6.1±3 years (range: 2 to 12 years). Thyroid morphology (n=33) was evaluated by palpation and ultrasonography. Thyroid function (n=30) was evaluated measuring total T3 and T4, and by the thyrotrophin-releasing hormone (TRH) test. Prolactin secretion was assessed before and after injection of TRH to evaluate the diagnostic test accuracy.
Results. One out of the 33 children (3%) was found to have a papillary carcinoma of thyroid four years after ALL treatment. Thyroid function was normal in all the patients, however one case (3%) showed high TSH (9.2 µU/mL) and prolactin (37.5 ng/mL) basal levels, but normal responses to TRH (TSH = 17.8 µU/mL; prolactin = 82.3 ng/mL). These hormonal alteration were not confirmed at follow-up: TSH = 1.6 µU/mL and prolactin = 13.7 ng/mL.
Conclusions. In this cohort of patients, the treatment of ALL was associated with one case of thyroid carcinoma, but it did not produce adverse effect on the thyroid function, at least after a follow-up lasted on average 6 years.