Thyroid Research Thyroid Research Archive Hypothyroidism

Children with brain tumors may have hypothyroidism and other endocrine problems after treatment

(March 2003)

The background of the study. Children with brain tumors who survive for many years may have endocrine and other adverse effects of treatment. This study was done to determine the frequency of endocrine and cardiovascular effects of treatment in long-term survivors of brain tumors.

How the study was done. The study subjects were 1607 children, adolescents, and young adults treated for a brain tumor between 1970 and 1986 who survived for at least five years after diagnosis. They were queried by mail or telephone about thyroid dysfunction and therapy, growth hormone deficiency and therapy, pubertal development and treatment of pubertal delay, and cardiovascular problems. At the time of diagnosis of brain tumor, 34 percent were ≤4 years old; 30 percent were 5 to 9 years old, and 36 percent were ≥10 years old. Most of the patients had an astrocytoma/glioma or medulloblastoma.

The results of the study. Sixteen percent of the patients had hypothyroidism; 21 percent had growth hormone deficiency, many of whom were treated with injections of growth hormone; 6 percent received some treatment to induce pubertal development. Less common problems were hyperthyroidism (1 percent), thyroid enlargement or nodules (2 percent), failure of onset of menstrual periods (2 percent), and low sperm counts (1 percent). All these problems and treatments were most common in the patients treated with surgery, radiation, and chemotherapy and least common in those treated with surgery alone.

Overall 18 percent had one adverse cardiovascular outcome or more (stroke, arrhythmia, blood clots, chest pain), of which stroke was the most common (5 percent).

The conclusions of the study. Among children with brain tumors who survive for five or more years after treatment, hypothyroidism and other endocrine problems are common.

The original article. Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, Stovall M, Yasui Y, Nicholson HS, Wolden S, McNeil DE, Mertens AC, Robison LL. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer 2003;97:663-73.