Euthyroid sick syndrome in children with Hodgkin disease

Euthyroid sick syndrome is related to profound changes in thyroid metabolis m induced by nonthyroidal diseases. To determine whether children with newl y diagnosed Hodgkin disease might present thyroid abnormalities and to esta blish their predictive value, the authors performed regular thyroid functio n testing. Seven children (5 M, 2 F) with a mean age of 10.4 years (range: 4.6-15 years) at diagnosis were studied for a period of 6.9 years (4.2-10.5 years). Five patients presented at diagnosis with euthyroid sick syndrome characterized by borderline low thyroxine circulating levels (T3 0.8-1.3 ng /mL, FT3 1.5-1.7 pg/mL) and mildly raised TSH (4.6-5 muU/mL). Thyroid funct ion turned normal within 6 months of therapy. Subsequently, 3 children deve loped overt hypothyroidism (T4 35-40 ng/mL, FT4 2-7 pg/mL, TSH 5.5-11 muU/m L) requiring substitution therapy. Euthyroid sick syndrome was not associat ed with a poorer outcome in terms of survival or long-term thyroid conseque nces. Thyroid function testing should be performed routinely at diagnosis a nd thereafter in children with Hodgkin disease to detect subtle abnormaliti es.