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First Published Online March 13, 2009
The Oncologist, Vol. 14, No. 3, 233-239, March 2009; doi:10.1634/theoncologist.2008-0156
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Head and Neck Cancers

Thyroid Storm After Intensity-Modulated Radiation Therapy: A Case Report and Discussion

Roberto Diaza, Marc D. Blakeya, Patrick B. Murphyb, A. Keith Cryarc, Anthony J. Cmelaka

aDepartment of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; bTennessee Oncology, Franklin, Tennessee, USA; c Maury Regional Medical Center, Columbia, Tennessee, USA

Key Words. Thyroid storm • IMRT • Head and neck cancer • Thyrotoxicosis

Correspondence: Anthony J. Cmelak, M.D., Vanderbilt University Medical Center, 1301 Medical Center Drive, B-901 TVC, Nashville, Tennessee 37211, USA. Telephone: 615-322-2555; Fax: 615-343-6589; e-mail: Anthony.Cmelak{at}Vanderbilt.edu

Received July 22, 2008; accepted for publication February 12, 2009; first published online in THE ONCOLOGIST Express on March 13, 2009.

Disclosures: Roberto Diaz: None; Marc D. Blakey: None; Patrick B. Murphy: None; A. Keith Cryar: None; Anthony J. Cmelak: Consultant/advisory role: Amgen, Bristol-Myers Squibb, Sanofi-Aventis; Honoraria: Bristol- Myers Squibb, Sanofi-Aventis.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

A 43-year-old man with locally advanced squamous cell carcinoma of the base of tongue was treated with induction chemotherapy followed by intensity-modulated radiation therapy (IMRT). Within 20 days post-treatment, the patient developed clinical symptoms highly suggestive of hyperthyroidism. Two and one half months after completion of therapy, the patient developed severe thyrotoxicosis, which, in retrospect, appears to have met the criteria for thyroid storm. This case history illustrates a previously unreported, life-threatening complication of external-beam radiation that should be considered in patients receiving IMRT therapy involving the thyroid. Diagnosis of the patient's hyperthyroidism and probable thyroid storm was difficult to recognize because of the significant overlap between the signs and symptoms of severe thyrotoxicosis and the expected toxicities of his cancer therapy.






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