Radiation-induced thyroid cancer
- Arthur B Schneider, MD, PhD
Arthur B Schneider, MD, PhD
- Professor Emeritus of Medicine
- University of Illinois at Chicago College of Medicine
- R Michael Tuttle, MD
R Michael Tuttle, MD
- Professor of Medicine
- Memorial Sloan Kettering Cancer Center
- Section Editors
- David S Cooper, MD
David S Cooper, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Thyroid Disease
- Professor of Medicine and International Health
- Johns Hopkins University School of Medicine
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
Radiation exposure of the thyroid during childhood is the most clearly defined environmental factor associated with benign and malignant thyroid tumors. The risk of thyroid cancer following irradiation is related to radiation dose and age (greater for children exposed early in life), and the risk persists throughout life. Radiation exposure during childhood also increases the risk of benign thyroid nodules and hypothyroidism.
The purpose of this topic is to review the evaluation of a patient with a history of childhood radiation exposure and how such a history affects treatment of patients with thyroid tumors. Radiation injury to other organs is reviewed separately. (See "Biology and clinical features of radiation injury in adults" and "Treatment of radiation injury in the adult" and "Clinical features of radiation exposure in children" and "Management of radiation exposure in children following a nuclear disaster".)
Type of exposure — Radiation exposure may be external or internal.
●External – The predominant types of external radiation are diagnostic radiographs, therapeutic radiation for the treatment of cancer, and historical use of external radiation to treat a wide variety of nonmalignant conditions. External radiation also includes brachytherapy, whereby a sealed radiation source is placed adjacent to a treatment area.
●Internal – Internal radiation exposure includes ingestion of foods or liquids contaminated with radioactivity or by inhalation of radioactive gases or particles. Internal radiation occurs after exposure to nuclear fallout (from testing and accidents at operating nuclear power plants or above ground nuclear explosive testing) or after ingestion of radioiodine for diagnostic tests and for therapy of hyperthyroidism.
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- RADIATION EXPOSURE
- Type of exposure
- Effect on thyroid
- - Tumorigenesis
- Magnitude of exposure
- - Very-low-dose exposure
- - Low-dose exposure
- - High-dose exposure
- Other radiation-related tumors
- Who might benefit from surveillance?
- General evaluation
- - History
- - Physical examination
- - Surveillance for functional thyroid abnormalities
- Surveillance for structural thyroid abnormalities
- - Risk assessment
- - Potential benefits and harms of routine ultrasound screening
- - Optimal timing and duration if ultrasound surveillance initiated
- DETECTION OF RADIATION-RELATED THYROID NODULES
- Clinical presentation
- - Ultrasound
- - Fine-needle aspiration biopsy
- - Thyroid cancer
- - Benign nodules
- PREVENTION OF RADIATION-RELATED THYROID DISEASE
- Medical radiation exposure
- Potassium iodide for thyroid protection in a nuclear accident
- SUMMARY AND RECOMMENDATIONS