Thyroid dysfunction is associated with osteoporosis in patients with Hodgkin's lymphoma

Background and Aim: Radiation therapy (RT) is a cornerstone component of the treatment for many subjects with Hodgkin's lymphoma (HL). Current variants of treatment for HL are mostly efficient, but can have a negative pronounced damaging effect on some anatomical structures. Specifically, RT can induce thyroid dysfunction and disorders of bone remodeling. The object of investigation was to assess the prevalence of thyroid dysfunction in HL survivors and estimate its effect on bone mineral density (BMD). Methods: The analysis included 160 patients with HL between the ages of 18 and 65 years, observed in Hematology Center of Novosibirsk. Seventy one patients had limited stage (I-II) and 84 individuals had stage III or IV of HL. Standard first-line regimens (ABVD, BEACOPP, BEACOPP-14) were given all patients. Neck and supraclavicular RT was performed in 96 (60%) individuals; the total dose was 30 Gy in 84 patients and 36 Gy in 11 ones. Thyroid hormones were measured by enzyme immunoassays. The BMD was measured by bone densitometry (DXA). Statistical analysis of the data was processed using STATISTICA (StatSoft, Inc., USA). Results: The changes in thyroid function were revealed in 40 (25%) patients. Among them, primary hypothyroidism was verified in 30 subjects, including 18 individuals with subclinical hypothyroidism. Ten patients had central hypothyroidism. Thirty two patients had neck and supraclavicular RT in their anamnesis. In this subgroup, hypothyroidism was observed in 22 subjects with total focal dose of 30 Gy and in 8 subjects with the total focal dose of 36 Gy. The decline of BMD was demonstrated in 76 individuals with HL (47.5%), the diagnosis of osteoporosis was revealed in 43 patients. Disorders of Bone Remodeling were more common in patients with hypothyroidism as compared to those without (χ2=13.4, p<; 0.001). Conclusion: Hypothyroidism is associated with decrease in BMD in subjects with HL. The screening for thyroid dysfunction and DXA should be included in follow-up in HL survivors.