Kaplan M M, Garnick M B, Gelber R, Li F P, Cassady J R, Sallan S E, Fine W E, Sack M J
Am J Med. 1983 Feb;74(2):272-80. doi: 10.1016/0002-9343(83)90626-5.
Thyroid evaluations were performed in 95 patients who received radiotherapy to the neck region for childhood cancer five to 34 years earlier. Fifty-six patients (61 percent) had at least one abnormality of serum free thyroxine index, serum thyroid-stimulating hormone (thyrotropin), or thyroid palpation. Seven had subnormal free thyroxine index and 40 had elevated thyrotropin concentrations. Thyroidal radiation doses of 3,000 or more rads and lymphangiography independently increased the risk (p less than or equal to 0.01) of an elevated serum thyrotropin concentration (present in 11 percent of patients with neither risk factor, 50 percent of those who underwent lymphangiography and received less than 3,000 rads, 46 percent of those who had 3,000 or more rads and no lymphangiography, and 76 percent of those with both), but duration of follow-up did not. Twenty-six patients had thyroid nodules and six others had diffuse thyroid enlargement. The frequency of palpable abnormalities increased with the follow-up time after radiation (30 percent of patients followed up less than 10 years had abnormalities versus 43 percent of those followed up 10 or more years, p = 0.03), but was not related to the serum thyrotropin level, radiation dose, or lymphangiography. Among 10 patients who had surgery for nodules, three had localized papillary thyroid carcinomas.
对95名曾在5至34年前因儿童癌症接受颈部放疗的患者进行了甲状腺评估。56名患者（61%）至少有一项血清游离甲状腺素指数、血清促甲状腺激素（促甲状腺素）或甲状腺触诊异常。7名患者游离甲状腺素指数低于正常，40名患者促甲状腺素浓度升高。甲状腺辐射剂量达到或超过3000拉德以及淋巴管造影独立增加了血清促甲状腺素浓度升高的风险（p≤0.01）（在无任何风险因素的患者中，该情况占11%；在接受淋巴管造影且辐射剂量低于3000拉德的患者中占50%；在接受3000拉德或更高剂量辐射且未进行淋巴管造影的患者中占46%；在两者兼具的患者中占76%），但随访时间并无此影响。26名患者有甲状腺结节，另外6名有弥漫性甲状腺肿大。可触及异常的发生率随放疗后的随访时间增加（随访时间少于10年的患者中30%有异常，而随访10年或更长时间的患者中为43%，p = 0.03），但与血清促甲状腺素水平、辐射剂量或淋巴管造影无关。在10名因结节接受手术的患者中，3名患有局限性甲状腺乳头状癌。
