title: Comparison of Thyroid Nodule Prevalence by Ultrasound in Childhood Cancer Survivors With and Without Thyroid Radiation Exposure.
abstract: OBJECTIVE
  Children receiving radiotherapy of the head, neck, or chest as treatment of primary malignancies are at increased risk for secondary thyroid malignancy. We hypothesized that current standards (yearly thyroid physical examination) lead to a substantial number of missed thyroid nodules. Our objectives were: (1) use thyroid ultrasound to assess thyroid nodules in childhood cancer survivors; and (2) compare prevalence of thyroid nodules in thyroid radiation-exposed patients as compared with cancer survivors without radiation exposure.
  
  
  METHODS
  We recruited 60 patients with thyroid radiation and chemotherapy exposure (median age at cancer diagnosis 10.8 y) and 59 patients with chemotherapy exposure alone (median age at diagnosis 4.3 y) from our long-term survivorship clinics. Each patient had a thyroid physical examination and thyroid ultrasound performed.
  
  
  RESULTS
  Thirty-three patients (27.7%) had nodules >0.3 cm of which 2 were palpated (6.1%). We found 22 radiated patients (36.7%) with nodules versus 11 nonradiated patients (18.6%) (P=0.03). Eleven patients were biopsied and 1 diagnosis of secondary papillary thyroid carcinoma was confirmed.
  
  
  CONCLUSIONS
  Our study supports further examination of incorporating thyroid ultrasounds into long-term survivorship follow-up guidelines in radiation-exposed patients for the detection of thyroid nodules and secondary malignancies.
authors.affiliation: *Division of Pediatric Hematology/Oncology ‡Department of Pediatric Endocrinology, Nationwide Children's Hospital/The Ohio State University †Center for Gene Therapy ∥Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital §Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Agrawal
authors.forename: Lory
authors.initials: L
authors.lastname: Guthrie
authors.forename: Mollie S
authors.initials: MS
authors.lastname: Sturm
authors.forename: Joseph
authors.initials: J
authors.lastname: Stanek
authors.forename: Laura
authors.initials: L
authors.lastname: Martin
authors.forename: Maria
authors.initials: M
authors.lastname: Henwood-Finley
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Aldrink
authors.forename: Randal
authors.initials: R
authors.lastname: Olshefski
authors.forename: Sarah H
authors.initials: SH
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D014463:Ultrasonography; D055815:Young Adult