Hypothyroidism after 131I-monoclonal antibody treatment of neuroblastoma.
BACKGROUND
To determine the prevalence of and risk factors for primary hypothyroidism following treatment with a radiolabeled monoclonal antibody ((131)I-3F8) in children with neuroblastoma.


METHODS
In the current study, we assessed thyroid function in 51 neuroblastoma patients who survived for > or =3 months after treatment with (131)I-3F8 (a murine IgG3 monoclonal antibody that reacts with the ganglioside GD2) at 4 mCi/kg/day x 5 days (total 20 mCi/kg). Prior therapy in all subjects included dose-intensive chemotherapy; 13 subjects also received external beam radiation to the neck. Oral iodide and liothyronine sodium (T3) were administered for protection of the thyroid gland.


RESULTS
Thirty-two of 51 subjects (63%) developed hormonal evidence of primary hypothyroidism. The median time to hypothyroidism after treatment with (131)I-3F8 was 6.4 months. The probability of developing hypothyroidism was 56% at 2 years following treatment with (131)I-3F8. There was evidence for an association between thyroidal uptake of (131)I and development of hypothyroidism (hazard ratio 1.83, 95% confidence interval 0.91-3.30; P = 0.09).


CONCLUSIONS
We conclude that hormonal evidence of primary hypothyroidism developed in a majority of subjects treated with (131)I-3F8, despite pretreatment with oral iodide plus liothyronine sodium. Alternative strategies for thyroid gland protection are needed.
Bhandari
Sonal
S
Department of Pediatrics, New York Presbyterian-Weill Cornell Medical College, New York, New York, USA.
Cheung
Nai-Kong V
NK
Kushner
Brian H
BH
Kramer
Kim
K
Modak
Shakeel
S
Larson
Steven M
SM
Yeh
Samuel
S
Heller
Glenn
G
Sklar
Charles A
CA
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000628:therapy*; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use*; D007167:Immunotherapy; D007223:Infant; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009447:Neuroblastoma / Q000175:diagnosis / Q000628:therapy*; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
C419226:3F8 antibody; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007074:Immunoglobulin G; D007457:Iodine Radioisotopes