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2018 ; 59
(suppl_2
): ii98-ii107
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Radiation-related thyroid autoimmunity and dysfunction
#MMPMID29069397
Nagayama Y
J Radiat Res
2018[Apr]; 59
(suppl_2
): ii98-ii107
PMID29069397
show ga
The thyroid gland is vulnerable not only to external radiation but also to
internal radiation, because the thyroid cells can incorporate radioactive iodine
when synthesizing thyroid hormones. Since radiation-induction of thyroid
neoplasia, including thyroid cancer, is well recognized, the data on
radiation-related thyroid autoimmunity and dysfunction are summarized and
reviewed. High-dose irradiation, irrespective of being external or internal, is
strongly associated with a risk of hypothyroidism (with the prevalence ranging
from 2.4% to 31%) and of Graves' hyperthyroidism (with the prevalence being up to
5%). It is easy to understand that high-dose irradiation induces hypothyroidism
with some frequency, because high-dose irradiation destroys the thyroid gland. On
the other hand, the basis for development of hyperthyroidism is mechanistically
unclear, and it is merely speculative that autoantigens may be released from
damaged thyroid glands and recognized by the immune system, leading to the
development of anti-thyrotropin receptor antibodies and Graves' hyperthyroidism
in subjects who are immunologically predisposed to this ailment. In contrast, the
data on moderate to low-dose irradiation on thyroid autoimmunity and dysfunction
are inconsistent. Although it is difficult to draw a definitive conclusion, some
data may suggest a transient effect of moderate- to low-dose irradiation on
hypothyroidism and autoimmune thyroiditis, implying that the effect, if it
exists, is reversible. Finally, no report has shown a statistically significant
increase in the prevalence of moderate- to low-dose irradiation-induced Graves'
hyperthyroidism.