Correlative study of dose to thyroid and incidence of subsequent dysfunction after head and neck radiation

Background: Thyroid dysfunction is common after radiotherapy (RT) for patients with head and neck cancers. We attempted to discover RT dose parameters that correspond with RT-induced thyroid dysfunction. Methods: Records of 102 patients who received RT from 2008 to 2010 were reviewed with respect to thyroid function. Abnormalities were grouped in 2 ways: (1) none, transient, or permanent; and (2) overt or subclinical. Results: At median follow-up of 33.5 months, incidence of any thyroid abnormality was 39.2% (women vs men – 50% vs 35%). Permanent dysfunction was seen in 24.5% with higher incidence in women versus men (42.9% vs 17.6%; p =.0081). Permanent abnormalities most strongly correlated with D_50% (p =.0275). V_50Gy also correlated with thyroid dysfunction post-RT (p =.0316). Concurrent chemotherapy increased permanent dysfunction (p =.0008). Conclusion: Achieving D_50% <50 Gy, V₅₀ <50%, and mean dose <54.58 Gy during RT planning may decrease the incidence; whereas female sex and concurrent chemotherapy seem to increase the risk of RT-induced hypothyroidism.