Graves' Disease Following Irradiation for Hodgkin's Disease

THE THYROID gland is commonly included in the radiation field in patients with Hodgkin's disease treated with radiation therapy. The so-called mantle field routinely includes the neck. A substantial number of patients with non-Hodgkin's lymphoma, head and neck tumors, and breast carcinoma also receive neck irradiation. The thyroid was traditionally considered a radioresistant organ. However, several reports on thyroid dysfunction following neck irradiation have appeared in recent years. Glatstein et al1reported a 44% incidence of elevated serum thyroid-stimulating hormone (TSH) concentration in patients with lymphomas who had lymphangiography and received neck irradiation. In 11% of these patients, clinical hypothyroidism or evidence of thyroid hypofunction (according to laboratory tests other than serum TSH determination) developed. Although the exact incidence and pathogenesis are not known, hypothyroidism is a recognized complication of thyroid irradiation. Graves' disease following thyroid irradiation, manifested either as hyperthyroidism or ophthalmopathy, is not a well-recognized entity. Report