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Risk factors for radiation-induced hypothyroidism

A literature-based meta-analysis

  1. Ivan R. Vogelius PhD1,†,*,
  2. Søren M. Bentzen PhD, DSc2,
  3. Maja V. Maraldo MD1,
  4. Peter M. Petersen MD, PhD1,
  5. Lena Specht MD, DMSc1,3

Article first published online: 12 MAY 2011

DOI: 10.1002/cncr.26186

Issue

Cancer

Cancer

Volume 117, Issue 23, pages 5250–5260, 1 December 2011

Additional Information

How to Cite

Vogelius, I. R., Bentzen, S. M., Maraldo, M. V., Petersen, P. M. and Specht, L. (2011), Risk factors for radiation-induced hypothyroidism. Cancer, 117: 5250–5260. doi: 10.1002/cncr.26186

Author Information

  1. 1

    Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

  2. 2

    Departments of Human Oncology, Biostatistics, and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

  3. 3

    Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

  1. †

    Fax: (011) 45-3545-3990

*Department of Radiation Oncology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø

  1. †

    Fax: (011) 45-3545-3990

Publication History

  1. Issue published online: 18 NOV 2011
  2. Article first published online: 12 MAY 2011
  3. Manuscript Revised: 22 MAR 2011
  4. Manuscript Accepted: 22 MAR 2011
  5. Manuscript Received: 8 FEB 2011

Funded by

  • The Lundbeck Foundation Center for Interventional Research in Radiation Oncology (CIRRO)
  • The Danish Council for Strategic Research
  • The Novo Nordisk Foundation
  • National Cancer Institute. Grant Number: 2P30 CA 014520-34

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Keywords:

  • hypothyroidism;
  • radiotherapy;
  • radiation oncology;
  • radiation tolerance;
  • thyroidectomy;
  • thyroid-stimulating hormone;
  • radiobiology

Abstract

BACKGROUND:

A systematic overview and meta-analysis of studies reporting data on hypothyroidism (HT) after radiation therapy was conducted to identify risk factors for development of HT.

METHODS:

Published studies were identified from the PubMed and Embase databases and by hand-searching published reviews. Studies allowing the extraction of odds ratios (OR) for HT in 1 or more of several candidate clinical risk groups were included. A meta-analysis of the OR for development of HT with or without each of the candidate risk factors was performed. Furthermore, studies allowing the extraction of radiation dose-response data were identified for a meta-analysis of the dose-response curve.

RESULTS:

Female gender (OR = 1.6; 95% confidence interval [CI], 1.3-1.9; P < .00001), surgery involving the thyroid gland (OR = 8.3; 95% CI, 5.7-12.0; P < .00001), or other neck surgery (OR = 1.7; 95% CI, 1.16-2.42; P = .006) were associated with a higher risk of HT. Caucasians were at higher risk of HT than African Americans (OR = 4.8; 95% CI, 2.8-8.5; P < .00001). The data showed association between lymphangiography and HT but with evidence of publication bias. There was a radiation dose-response relation with a 50% risk of HT at a dose of 45 Gy but with considerable variation in the dose response between studies. Chemotherapy and age were not associated with risk of HT in this analysis.

CONCLUSIONS:

Several clinical risk factors for HT were identified. The risk of HT increases with increasing radiation dose, but the specific radiation dose response varies between the studies. The most likely cause of this heterogeneity is differences in follow-up between studies. Cancer 2011;. © 2011 American Cancer Society.

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