title: Patients exposed to diagnostic head and neck radiation for the management of shunted hydrocephalus have a significant risk of developing thyroid nodules.
abstract: OBJECTIVE
  External radiation to the head and neck can lead to an increased incidence of thyroid nodules. We investigated whether patients requiring repeated head and neck imaging for the management of shunted hydrocephalus had a higher incidence of ultrasound-detected thyroid nodules compared to reports of comparable age.
  
  
  METHODS
  Patients treated at our institution for shunted hydrocephalus from 1990 to 2003 were contacted. Enroled patients underwent a thyroid ultrasound. Demographic data and radiation exposure history were obtained retrospectively.
  
  
  RESULTS
  Thyroid nodules were identified sonographically in 15/112 patients (13.6 %). Patients with thyroid nodules were older (mean 24.3 ± 7.6 years) than those without (mean 18.4 ± 8.0 years) (p = 0.005). Those with a detectable thyroid nodule had a longer follow up time compared to those who did not (mean 21.9 ± 5.5 vs. 15.1 ± 7 years, respectively) (p = 0.018).
  
  
  CONCLUSIONS
  Patients with shunted hydrocephalus are exposed to substantial head and neck radiation from diagnostic imaging and have a higher incidence of thyroid nodules detected by ultrasonography. These patients should be provided ongoing surveillance for detection of thyroid nodules and the possibility of malignancy.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA. Jennifer.aldrink@nationwidechildrens.org.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Aldrink
authors.affiliation: Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Adler
authors.affiliation: The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Haines
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Watkins
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA.
authors.forename: Mika
authors.initials: M
authors.lastname: Matthews
authors.affiliation: Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Lacey
authors.initials: L
authors.lastname: Lubeley
authors.affiliation: Department of Biostatistics, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA.
authors.forename: Denis R
authors.initials: DR
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000601:surgery; D015994:Incidence; D008297:Male; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016606:Thyroid Nodule / Q000453:epidemiology / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Hydrocephalus; Radiation; Thyroid malignancy; Thyroid nodule