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White Race As a Risk Factor for Hypothyroidism After Treatment for Pediatric Hodgkin's Lymphoma

Monika L. Metzger, Melissa M. Hudson, Grant W. Somes, Ron I. Shorr, Chin-Shang Li, Matthew J. Krasin, John Shelso, Ching-Hon Pui, Scott C. Howard

From the Departments of Hematology-Oncology, Biostatistics, and Radiological Sciences and the Division of Endocrinology, St Jude Children's Research Hospital; and College of Medicine and Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN

Address reprint requests to Monika L. Metzger, MD, Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794; e-mail: monika.metzger{at}stjude.org

PURPOSE: Hypothyroidism frequently occurs after treatment for pediatric Hodgkin's lymphoma, but race has not been investigated as a risk factor for this delayed toxicity. The aim of this study was to determine whether race is an independent risk factor for hypothyroidism in survivors of pediatric Hodgkin's lymphoma.

PATIENTS AND METHODS: To identify differences between black and white patients in the development of hypothyroidism after treatment for Hodgkin's lymphoma, we conducted a retrospective study of consecutively treated pediatric patients with newly diagnosed Hodgkin's lymphoma treated at St Jude Children's Research Hospital (Memphis, TN) from January 1980 through December 2002. Clinical or biochemical hypothyroidism was defined by an above normal thyroxine-stimulating hormone concentration or by the need for thyroid hormone replacement therapy.

RESULTS: The 461 patients (388 white patients, 73 black patients) where followed for a median of 11.3 years (range, 1.8 to 24.9 years). Hypothyroidism developed in 196 (43%) of 461 patients after a median of 2.9 years (range, 0.7 to 11.3 years) after diagnosis of Hodgkin's lymphoma. Hypothyroidism developed in 47% of white patients but in only 21% of black patients (hazard ratio = 2.7; 95% CI, 1.6 to 4.6). After adjusting for other risk factors for hypothyroidism (thyroid radiation dose, sex, and nodular sclerosis histology), the risk of hypothyroidism in white patients was 2.5 times (95% CI, 1.5 to 4.3 times) the risk in black patients (P < .001).

CONCLUSION: White patients have a higher risk of hypothyroidism after neck irradiation for pediatric Hodgkin's lymphoma than black patients.

Supported by Grants No. R01-CA600419 and P30-CA21765 from the National Institutes of Health, by the American Cancer Society F.M. Kirby Clinical Research Professorship, and by the American Lebanese Syrian Associated Charities.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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