CoChat
Sign Up
Cited by 152Pituitary Gland Disorders and TreatmentsThyroid Disorders and TreatmentsGrowth Hormone and Insulin-like Growth Factors

Diagnosis of Hidden Central Hypothyroidism in Survivors of Childhood Cancer1

Rose, Susan R., Lustig, Robert H., Pitukcheewanont, Pisit, Broome, Dean C., Burghen, George A., Li, Hao, Hudson, Melissa M., Kun, Larry E. +1 more·1999·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.84.12.6097
Open this paper in CoChat — free account

Abstract

To determine how often central hypothyroidism remains undetected by routine out-patient tests of thyroid hormone, we studied 208 pediatric cancer survivors referred for evaluation because of signs of subtle hypothyroidism or hypopituitarism. Of the 208 (68 females and 140 males), 110 had brain tumors, 14 had other head/neck tumors, 11 had solid tumors remote from head and neck, and 73 had leukemia. Patients were evaluated 1-16 yr (mean, 6.1+/-4.1 yr) after tumor diagnosis. The nocturnal TSH surge and response to TRH were measured. Of 160 patients with free T4 in lowest third of normal, 34% had central hypothyroidism (blunted TSH surge or low/delayed TSH peak or delayed TSH decline after TRH); 9% had central hypothyroidism with mild TSH elevation (mixed hypothyroidism). Another 16% had mild primary hypothyroidism (TSH, 5-15 mU/L). Of 48 with free T4 in the upper two thirds of normal, 14% had central hypothyroidism; 17% had mild primary hypothyroidism. Incidence of central, mixed, and mild primary hypothyroidism 10 yr after tumor diagnosis was significantly related to total cranial radiation dose (P < 0.0001). Of 62 patients with central hypothyroidism, 34% had not developed GH deficiency. TSH surge identified 71%, and response to TRH identified 60% of those with central hypothyroidism. More than half of the slowly growing patients who have received cranial or craniospinal radiation for childhood cancer develop subtle hypothyroidism. In our study group, 92% of patients with central hypothyroidism and 27% with mixed hypothyroidism would have remained undiagnosed using baseline thyroid function tests alone. Both TSH surge and response to TRH must be evaluated to identify all of these patients.

Integrity signals

Registry

Crossref · 10.1210/jcem.84.12.6097

Cites

68 of 68 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.

Cites

Flagged first, then by citations

1 of the 69 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Rose, S. R., Lustig, R. H., Pitukcheewanont, P., Broome, D. C., Burghen, G. A., Li, H., Hudson, M. M., Kun, L. E., & Heideman, R. L.
Affiliations
St. Jude Children's Research Hospital (US)
Corresponding author
Rose, Susan R.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
1999-12
Volume
84
Issue
12
Pages
4472-4479
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.84.12.6097
OpenAlex
W2118110964
Cited by
139
References
69
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 8 · 2017: 4 · 2016: 4 · 2015: 4 · 2014: 5 · 2013: 4 · 2012: 8
FWCI
3.69
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • St. Jude Children's Research Hospital (CA21765)
  • American Lebanese Syrian Associated Charities (CA 21765)
  • National Institutes of Health (CA21765))
  • National Cancer Institute (CA21765, CA-21765-21, 21765, P30CA021765)
  • National Center for Research Resources (M01RR-00211, M01RR000211)
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
Keywords
central hypothyroidism, childhood cancer survivors, hypopituitarism, TRH stimulation test, cranial irradiation, radiation-induced hypothyroidism, thyroid function tests, primary hypothyroidism, GH deficiency, leukemia survivors, brain tumor survivors
MeSH terms
Adolescent, Brain Neoplasms, Child, Child, Preschool, Female, Head and Neck Neoplasms, Humans, Hypothyroidism, Infant, Leukemia, Male, Neoplasms, Radiotherapy, Thyrotropin, Thyrotropin-Releasing Hormone, Thyroxine

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