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Thyroid problems

Anyone, even people who have never had cancer, can develop thyroid problems. However, some cancer treatments can increase the risk. It is important that you recognise and understand the symptoms and signs that may indicate thyroid problems.

What are thyroid problems?

The thyroid gland is located just above the hollow in your neck and produces the thyroid hormones T3 and T4. These hormones are essential for growth and for the development of the brain. The function of the thyroid gland is regulated by the hormone TSH (thyroid-stimulating hormone), which is produced in the brain.

Sometimes thyroid problems occur:

  • The thyroid works too slowly and produces too few hormones (hypothyroidism).

  • The thyroid works too quickly and produces too many hormones (hyperthyroidism).

Do I have an increased risk of thyroid problems?

Anyone — even people who have never had cancer — can develop thyroid problems. However, some cancer treatments can increase the risk.

The following treatments can increase the risk of thyroid problems:

  • Radiation therapy to the thyroid or to an area where the thyroid is located can cause hypothyroidism and hyperthyroidism.

  • Allogeneic stem cell transplantation (from a donor) can cause hypothyroidism and hyperthyroidism.

  • Surgery in which the thyroid gland is removed always leads to hypothyroidism.

  • Treatment with radioactive iodine (I-131 or MIBG) can increase the risk of hypothyroidism.

You can check the summary of your treatment to see whether you have had one or more of these treatments. If you do not have a summary, you can contact the LATER clinic or the hospital where you were treated.

Thyroid problems do not always have to be caused by treatment. Other causes are also possible, such as certain medications. Sometimes thyroid problems have no clear cause. It is estimated that almost one in ten people has thyroid problems. They occur more often in women than in men.

What are symptoms and signs of thyroid problems?

Certain symptoms and signs may indicate thyroid problems. Even if you do not currently have these symptoms, it is important to recognize them in case they appear in the future.

Symptoms and signs of hypothyroidism (too little thyroid hormone):

  • Weight gain

  • Constipation

  • Feeling cold quickly

  • Hair loss or thinning hair

  • Dry skin

  • Fatigue

In children and teenagers:

  • Being small and poor growth

  • Difficulty with attention and concentration at school

  • Delayed puberty

Symptoms and signs of hyperthyroidism (too much thyroid hormone):

  • Unexplained weight loss

  • Heart palpitations (irregular or unusually fast heartbeat)

  • Feeling nervous, irritable, or anxious

  • Mood swings

  • Trembling hands

  • Diarrhea

  • Persistent (severe) fatigue

  • Sweating more than normal

  • Insomnia

  • Hair loss or thinning hair

  • A thyroid that can be felt or seen

  • Eye problems, especially in adults

I have an increased risk of thyroid problems. What tests will I have and when?

If you have an increased risk of thyroid problems, the advice is to:

  • Discuss your medical history and/or symptoms with your GP or LATER doctor.

  • Have blood tests to measure the TSH and T4 levels in your blood.

Recommended frequency:

  • Children (0–18 years): once per year

  • Adults (19 years and older): every 2–3 years

If you want to become pregnant:

  • Have blood tests before pregnancy.

  • During pregnancy, have TSH and T4 levels checked regularly.

If a blood test result is abnormal, the test may sometimes be repeated.

What else can I do?

If you have thyroid problems, your GP or LATER doctor will probably refer you to an endocrinologist (a doctor specialized in hormones and metabolism). The endocrinologist will discuss treatment options with you, such as hormone therapy.

Living with an increased risk of thyroid problems

Living with (an increased risk of) thyroid problems can be difficult. Talking with friends and family can help. It can also be helpful to connect with people in a similar situation, for example through a patient organization such as VOX, part of the Childhood Cancer Netherlands Association.

Take good care of yourself. Although it does not reduce the risk of thyroid problems, a healthy lifestyle remains important. Also take care of your mental health. Small changes can already have a positive effect on your physical and mental well-being.

It is important that you know you have an increased risk of thyroid problems and that you recognize the symptoms and signs. If you have questions or concerns after reading this information, contact your GP or LATER doctor.

Where can I find more information?

On the LATER website you can also find information about:

  • Healthy lifestyle

  • Mental health

  • Second type of cancer: thyroid tumor

In the PanCare Plain Language Summaries you can find links to reliable information in English. If you search online for information about late effects, keep in mind that some information may be outdated or incorrect.

Disclaimer

This information is based on the plain-language summary of the guideline created by the PanCare Plain Information Group and has been adapted where necessary to the Dutch LATER guideline. If you experience symptoms or signs, do not rely solely on this information — contact your GP, LATER doctor, or specialist.