CoChat
Sign Up
Cited by 107Pituitary Gland Disorders and TreatmentsEffects of Radiation ExposureThyroid Disorders and Treatments

A population-based study of thyroid function after radiotherapy and chemotherapy for a childhood brain tumor

Schmiegelow, M., Feldt-Rasmussen, U., Rasmussen, A. K., Poulsen, H. S., Müller, J.·2003·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2002-020380
Open this paper in CoChat — free account

Abstract

The effect of craniospinal irradiation (CSI) vs. cranial irradiation (CIR) only with or without chemotherapy (CT) on the hypothalamus/pituitary (HP) thyroid axis was assessed in a population-based study of patients treated for a childhood brain tumor not directly involving the HP axis. Thyroid function was evaluated and compared with that in healthy controls (n = 27), measuring TSH, free T4, total T4, total T3, and TRH. The biological effective dose (BED) of radiotherapy, determined for the HP region and spine and expressed in grays (Gy) as BED, gives a means of expressing the biological effects of different dosage schedules in a uniform way. Seventy-one children (45 males and 26 females), less than 15 yr of age when diagnosed between 1970-1997 in the eastern part of Denmark, were included. Twenty-nine had received CSI, and 42 had received CIR only. The median age at time of radiotherapy was 8.4 yr (range, 0.8-14.9). The median length of follow-up was 12.0 yr (range, 2.0-28.0). There was no significant difference between CSI and the CIR only patients with respect to median BED to the HP region. Primary hypothyroidism was found in 24%, of whom 71% had been treated with CSI and 29% with CIR only; 73% had compensated hypothyroidism, and 27% had overt primary hypothyroidism. Central hypothyroidism was found in 6%. Free T4 and total T3 were significantly lower in the CSI and CIR only groups compared with controls. As the CIR only group had significantly higher median basal TSH levels compared with controls and as the CSI compared with the CIR only group and controls had significantly higher median basal TSH levels, we speculate that this was probably due to scattered irradiation from both cranial and spinal fields to the thyroid gland. There was a significant relation between basal TSH and time of follow-up (r(s) = -0.39; P = 0.001). Stepwise backward multiple linear regression analysis showed that the best-fit model to predict basal TSH was free T4 (P < 0.0001), the length of follow-up (P = 0.02), and total T3 (P = 0.06). In contrast, age at radiotherapy, BED to the HP region and spine, and whether the patient had been treated with CT were not included in the model. The TRH test showed significantly exaggerated and prolonged TSH responses for the CSI and CIR only groups compared with controls, indicating HP dysfunction. In conclusion, these data suggest that both CSI and CIR for childhood brain tumor may affect the HP-thyroid axis, resulting in hypothyroidism. CT had no significant influence on HP-thyroid function. We recommend prolonged surveillance of pituitary-thyroid function in long-term survivors of childhood brain tumor and institution of thyroid hormone replacement if the levels of TSH and free T4 are above and below the normal range, respectively, to ensure normal growth and metabolism.

Integrity signals

Registry

Crossref · 10.1210/jc.2002-020380

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In children, central hypothyroidism most commonly arises due to craniopharyngiomas or previous cranial irradiation for brain tumours, haematological malignancies, or genetic causes.

    “In children, central hypothyroidism most commonly arises due to craniopharyngiomas or previous cranial irradiation for brain tumours, haematological malignancies, or genetic causes.100”

    From Hypothyroidism (2024) · cites this paper as [100]

  • Craniopharyngiomas are the leading cause of acquired central hypothyroidism in children, followed by cranial irradiation for other childhood brain tumours.

    “Craniopharyngiomas are the leading cause of acquired central hypothyroidism in children, followed by cranial irradiation for other childhood brain tumours such as dysgerminomas or malignant haematological diseases (Gurney et al., 2003;Lando et al., 2001;Schmiegelow et al., 2003).”

    From The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions (2021) · cites this paper as Schmiegelow et al., 2003

Cites

Flagged first, then by citations

1 of the 23 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Schmiegelow, M., Feldt-Rasmussen, U., Rasmussen, A. K., Poulsen, H. S., & Müller, J.
Affiliations
Copenhagen University Hospital (DK)
Corresponding author
Schmiegelow, M.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2003-01
Volume
88
Issue
1
Pages
136-140
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2002-020380
OpenAlex
W2004448368
Cited by
107
References
23
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 13 · 2017: 7 · 2016: 3 · 2015: 10 · 2014: 4 · 2013: 5 · 2012: 2
FWCI
3.25
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords
pediatric brain tumors, craniospinal irradiation, cranial irradiation, hypothalamic-pituitary-thyroid axis, thyroid function, primary hypothyroidism, central hypothyroidism, biologically effective dose, thyroid-stimulating hormone, free thyroxine, total T3, chemotherapy, follow-up duration, pediatric oncology
MeSH terms
Adolescent, Antineoplastic Agents, Brain Neoplasms, Child, Child, Preschool, Female, Humans, Hypothyroidism, Infant, Male, Relative Biological Effectiveness, Thyroid Gland, Incidence, Cranial Irradiation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review