Radiotherapy-induced hyperthyroidism in a cystinotic kidney transplant patient with Hodgkin lymphoma.
Hypothyroidism is a well-known complication of cystinosis. PTLD incidence in pediatric renal transplant population ranges between 1 and 4.5%. We describe the case of a young cystinotic patient who developed hyperthyroidism after radiotherapy for Hodgkin lymphoma. He is a 23-yr-old male who was diagnosed with cystinosis at the age of two. He developed renal failure and other extrarenal complications but never presented hypothyroidism. At the age of 12, he received a successful kidney transplant from a cadaveric donor. Two yr later, EBV-positive Hodgkin lymphoma was diagnosed and chemotherapy and radiotherapy were administered. He achieved remission. Eight yr later, autoimmune hyperthyroidism secondary to previous radiation was detected, and he slowly became symptomatic. Clinical symptoms and laboratory data spontaneously normalized. This is the first case of a cystinotic patient developing hyperthyroidism. Thyroid disorders, especially hypothyroidism, have been reported in association with neck irradiation. Hypothyroidism would have been considered to be a late complication of cystinosis and not a consequence of radiotherapy. Thyroid hormones, clinical examination, and history evaluation for thyroid dysfunction should be periodically monitored after neck radiotherapy. The thyroid should always be excluded from the irradiation fields. Multidisciplinary interaction in difficult cases should be encouraged.
Guzzo
Isabella
I
Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Research Institute (IRCCS), Rome, Italy. isabella.guzzo@opbg.net
Di Zazzo
Giacomo
G
Grossi
Armando
A
Greco
Marcella
M
Dello Strologo
Luca
L
D000328:Adult; D005198:Fanconi Syndrome / Q000150:complications / Q000532:radiotherapy; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology*; D007674:Kidney Diseases / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009154:Mutation; D018787:Radiation Oncology / Q000379:methods; D011878:Radiotherapy / Q000009:adverse effects*; D013961:Thyroid Gland / Q000528:radiation effects*; D013963:Thyroid Hormones / Q000032:analysis; D016896:Treatment Outcome
D013963:Thyroid Hormones