Thyroid, parathyroid, and salivary gland evaluations in patients exposed to multiple fluoroscopic examinations during tuberculosis therapy: a pilot study.
The prevalence of thyroid, parathyroid, and salivary abnormalities was determined in 91 women who received an average of 112 fluoroscopic chest examinations during pneumothorax treatment for tuberculosis more than 40 yr previously and in 72 women treated for tuberculosis by other modalities. Thyroid abnormalities were determined by physical examination, scintiscans, and measurements of serum free T4 index, TSH, and thyroid microsomal antibodies. Thyroid nodules were diagnosed in 7.7% of the exposed and 4.2% of the comparison group (prevalence ratio, 1.8; 90% confidence interval 0.6-5.7). Autoimmune thyroid disease was diagnosed in 15.2% of the exposed and 6.9% of the comparison group (prevalence ratio, 2.2; 95% confidence interval, 0.8-6.2). No salivary tumors were detected. Two exposed women and 1 comparison woman had primary hyperparathyroidism. Although absorbed dose to the thyroid could not be precisely determined, approximately 60 rads would be expected to yield the observed excess of thyroid nodules. While the prevalence ratios were not significantly increased in the exposed group, the results suggest that susceptibility of the thyroid to nodules from cumulative radiation doses of this magnitude could be increased even when the doses are accumulated over years and that such x-ray exposure of the thyroid gland may predispose the patient to the development of autoimmune disease.
Kaplan
M M
MM
Department of Medicine, New England Medical Center Hospital, Boston, Massachusetts 02111.
Boice
J D
JD
Ames
D B
DB
Rosenstein
M
M
D001943:Breast Neoplasms / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000209:etiology; D010280:Parathyroid Glands / Q000473:pathology* / Q000528:radiation effects; D010865:Pilot Projects; D011030:Pneumothorax; D012469:Salivary Glands / Q000473:pathology* / Q000528:radiation effects; D013959:Thyroid Diseases / Q000209:etiology; D013961:Thyroid Gland / Q000473:pathology* / Q000528:radiation effects; D014397:Tuberculosis, Pulmonary / Q000473:pathology / Q000628:therapy*