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Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
THYROID PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
This PLAIN summary is based on the PanCareFollowUp guideline about “Thyroid function problems” [1] , which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Thyroid problems
The thyroid is a gland at the front of the neck. The most important function of the thyroid is to produce hormones. These hormones are called T3 (triiodothyronine) and T4 (thyroxine). Thyroid hormones control every cell and all the organs in the body. In children, thyroid hormones are important for the growth and development of the brain. Thyroid function is regulated by another hormone produced by the brain, called TSH (thyroid-stimulating hormone).
Sometimes problems can occur with thyroid function which can cause the thyroid to decrease the production of thyroid hormones. This is called hypothyroidism. On the other hand, the thyroid may also become overactive and produce too much T3 and T4, called hyperthyroidism.
The thyroid and thyroid hormones
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Hover over the letters/numbers in the figure for more information.
Hormone
Am I at higher risk of thyroid problems?
Anyone, including people who have never had cancer treatment, may develop thyroid problems. However, there are some cancer treatments that may increase the risk of having thyroid problems later in life. The problems that can occur depend on the type of cancer treatment received.
The following treatments can lead to, or increase the risk of, thyroid problems:
- Radiotherapy to the thyroid or an area including the thyroid may cause both hypo- and hyperthyroidism.
- Stem cell transplantation with stem cells from a donor (allogeneic). Stem cell transplantation may cause both hypo- and hyperthyroidism.
- Surgery, where the thyroid is removed (total thyroidectomy) always leads to hypothyroidism.
- Therapeutic radioactive iodine (I-131 or MIBG), a type of radiotherapy, may increase the risk of hypothyroidism.
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience thyroid problems, it does not always mean that this is caused by your cancer treatment. Thyroid problems may have other causes, such as other drugs unrelated to cancer treatment or autoimmunity. Thyroid problems may also occur without a clear cause (idiopathic). Nearly one in ten of the general population are likely to have thyroid problems, with an increased risk in females.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Autoimmune disease
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of thyroid problems?
There are symptoms and signs that can tell you if you might have thyroid problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have hypothyroidism (not enough thyroid hormones):
- Weight gain
- Constipation
- Feeling cold easily
- Hair loss or thin hair
- Dry skin
- Tiredness
In children and teens:
-
- Poor growth and short stature (short height)
- Difficulty concentrating or paying attention at school or work
- Delayed puberty
These symptoms and signs may suggest that you have hyperthyroidism (too much thyroid hormones):
- Unexplained weight loss
- Heart palpitations (the heartbeat may be irregular or unusually fast)
- Feeling nervous, irritable or anxious
- Mood swings
- Tremor – a fine trembling of the hands
- Diarrhoea
- Feeling (very) tired all the time
- Sweating more than usual
- Difficulty sleeping
- Hair loss or thin hair
- Swollen thyroid, lump in your neck (Goitre)
- Eye problems, especially in adults
If you recognise any of these symptoms or signs in yourself, please contact your general practitioner or follow-up care specialist.
Symptoms and signs
I am at higher risk of thyroid problems. What tests should I have and when?
If you are at higher risk of thyroid problems, it is advised to:
- Discuss your medical history and whether you experience(d) any symptoms and signs of thyroid problems with your general practitioner or follow-up care specialist.
- Have a blood test done to measure levels of TSH and T4 in the blood. If you are trying to become pregnant, it is important to have a blood test beforehand. It is also important to regularly measure your TSH and T4 levels during pregnancy.
The advised interval of testing depends on your age:
- Children (0-18 years): Once a year
- Adults (19 years and older): Every 2-3 years
If your blood tests are abnormal, it may be necessary to confirm the diagnosis by repeating the blood test.
What happens if I have thyroid problems?
If you have thyroid problems, your general practitioner or follow-up care specialist will probably refer you to an:
- Endocrinologist (physician who specialises in hormones and metabolism)
The endocrinologist may discuss different treatment options with you, such as hormone treatment.
Hormone treatment
What else can I do?
Knowing that you may be at increased risk of thyroid problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
Although it may not lower your risk of thyroid problems, it is still important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing thyroid problems and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about thyroid problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- Mayo Clinic: Here you can find more information about hypothyroidism in general
- American Thyroid Association: Here you can find more information about hypothyroidism in general
- National Institute of Health (NIH): Here you can find more information about iodine and recommendations for iodine intake
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Thyroid function problems” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext