Thyroid Profile in the First Three Months after Starting Treatment in Children with Newly Diagnosed Cancer

SIMPLE SUMMARY: Thyroid dysfunction during childhood may affect daily energy, growth, body mass index and bone development. Thyroid dysfunction may occur in children with cancer due to chemotherapy or other drugs, radiotherapy, the tumor itself or severe illness. The aim of this prospective study was to determine the percentage, severity and risk factors of changing thyroid hormone concentrations in the first three months of childhood cancer treatment. Subclinical hypothyroidism (normal thyroid hormones, with elevated thyroid stimulating hormone (TSH) according to age) was present in 8.2% of children at diagnosis and 2.9% of children three months after starting treatment. Subclinical hyperthyroidism (normal thyroid hormones, with lowered TSH values according to age) was present in 3.6% of children at diagnosis and 0.7% of children after three months. In 28% of children, the concentration of free thyroid hormone (FT4) decreased by ≥20%. We conclude that children with cancer are at low risk of developing hypo- or hyperthyroidism in the first three months after starting treatment but may develop a decline in FT4. ABSTRACT: Background: Thyroid hormone anomalies during childhood might affect neurological development, school performance and quality of life, as well as daily energy, growth, body mass index and bone development. Thyroid dysfunction (hypo- or hyperthyroidism) may occur during childhood cancer treatment, although its prevalence is unknown. The thyroid profile may also change as a form of adaptation during illness, which is called euthyroid sick syndrome (ESS). In children with central hypothyroidism, a decline in FT4 of >20% has been shown to be clinically relevant. We aimed to quantify the percentage, severity and risk factors of a changing thyroid profile in the first three months of childhood cancer treatment. Methods: In 284 children with newly diagnosed cancer, a prospective evaluation of the thyroid profile was performed at diagnosis and three months after starting treatment. Results: Subclinical hypothyroidism was found in 8.2% and 2.9% of children and subclinical hyperthyroidism in 3.6% and in 0.7% of children at diagnosis and after three months, respectively. ESS was present in 1.5% of children after three months. In 28% of children, FT4 concentration decreased by ≥20%. Conclusions: Children with cancer are at low risk of developing hypo- or hyperthyroidism in the first three months after starting treatment but may develop a significant decline in FT4 concentrations. Future studies are needed to investigate the clinical consequences thereof.