Thyroid function tests for the practicing physician.
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Biomedical subjects
Publications and source records attributed to G T Asteris.
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The clinical courses of 91 patients with radiation-associated thyroid cancer were compared with courses in a control population. Radiation-associated carcinoma appears to be a disease of younger persons, and 90% of the tumors are papillary. No anaplastic or medullary tumors were observed. Ninety percent of the tumors were larger than those found in an autopsy series that surveyed for "biologically benign" thyroid tumors. There was a higher incidence of multicentric disease, locally invasive disease, and distant metastases in the population that had had x-ray exposure. Although the population with x-ray exposure had had more aggressive treatment, more recurrences were present in patients who had had radiation therapy. The death rate was similar in both groups. Parathyroid adenoma occurred more frequently in the population that had radiation exposure than in controls and appears to be a radiation-associated illness.
Anti-thyroglobulin antibodies, anti-thyroid microsomal antibodies, serum thyroglobulin, and carcinoembryonic antigen were assayed in sera of patients with a history of thyroid irradiation and in patients with thyroid cancer. In irradiated patients, the frequency of positive results for each test was increased above the frequency found in a control population, with a significant increase at P less than .05 for TGHA and TG levels. However, the tests (with the exception of serum thyroglobulin) did not clearly segregate irradiated patients with benign or malignant lesions from those with no clinically detectable abnormalities. Elevations of serum thyroglobulin above 300 ng/ml were found only in patients with thyroid cancer, but in these patients the diagnosis was usually clinically obvious.
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Exposure to radiation results in an increased occurrence of nodularity to the thyroid and, more important, the development of cancer in a significant proportion of patients. Near-total thyroidectomy is recommended in those patients with a history of irradiation who are found on physical examination of the thyroid to have one or more nodules. Although pregnancy appears to have no effect on the course of thyroid carcinoma and the tumor has no effect on pregnancy, because of the numerous stimuli to thyroid growth during pregnancy, we feel that pregnancy is best avoided by women with known residual disease.