
<b>There are a lot of people with thyroid problems on the ACOR LMS list, probably because of many reasons:</b>:

1.  A shared faulty biochemical pathway that involves both thyroid disease and sarcomas.

2. Some thyroid disease is autoimmune.  There is an increased occurrence of malignancy in autoimmune disease.

3. The treatment for cancer often involves chemotherapy.  Chemotherapy can lead to the thyroid gland not working right, some of it might get destroyed.  

4. The treatment for cancer often involves radiation.  If the radiation field is aimed in the  direction of the thyroid, a dose of radiation can cause problems in the gland.

So the treatment for cancer sometimes causes thyroid problems.  [One study showed 16% of cancer patients had thyroid dysfunction of one type or another.]

5. Thyroid problems are somewhat common, anyway.  Some of the thyroid problems might not be related.

6. Some people have cancer syndromes...  that is they have faulty cancer suppressor genes.  These people can get growths on their thyroid as well as tumors on their thyroid as well as their LMS.

7. Intrathyroid metastases.

8. There are second primary cancers, where the primary cancer could be either LMS or a thyroid cancer, and the second primary cancer being a thyroid cancer or LMS.   

9. Probably there are other reasons too.



<b>Thyroid Function</b>

T3 and T4 are made by the thyroid gland.  they are the thyroid hormones.

TSH is made by the pituitary gland.  It is called Thyroid Stimulating Hormone.   TSH stimulates the thyroid to make more T4 and T3.

The pituitary gland contains sensors that can tell what the levels of thyroid hormone are.  If the thyroid hormone levels are low,  more TSH is made to stimulate the thyroid gland to make more.   If the thyroid hormone levels are high, less TSH is made to prevent the thyroid gland from making so much.

HyPOthyroidism means your T4 or T3 or both are low, and the TSH is high. This will make you sluggish, constipated, tired, sleep more, gain weight, lose hair, etc...  Slows your system down.

HyPER thyroidism means either your T4 or T3 or both are high, and the TSH is low.This will make you insomniac, lose weight or eat prodigiously or both, have thick hair and fast nail growth, perhaps give you diarrhea... revs your system up.

If your pituitary is not working right, because of radiation or operation, the TSH will not be made.   You will have a low TSH [it's not being made] and a low T4 as well, because the TSH is not stimulating the thyroid gland to make it.   So hypothyroidism, can come from pituitary failure as well.

People who are very sick or very depressed or anorexic, sometimes have low TSH and low T4 as well.  But they are not hypothyroid.  This is called the sick euthyroid syndrome.   [Eu thyroid is normal levels, not hypo or hyper].

Synthroid is manmade thyroid hormone.  It is given as a pill for replacement if your thyroid hormone levels are too low.



<b>Recovery from the euthyroid sick syndrome induced by tumor necrosis factor alpha in cancer patients.</b>

Cytokines have been implicated in the pathogenesis of the euthyroid sick syndrome. ... The recovery from this euthyroid sick syndrome is, at least in part, TSH-dependent, since the prolonged elevation of TSH values preceded and persisted during the normalization of T3 and the elevation of T4 levels. This biphasic pattern of induction of and recovery from the euthyroid sick syndrome may be a general feature of nonthyroidal disease. The euthyroid sick syndrome should be interpreted not only in relation to the presence of nonthyroidal diseases but also in relation to the recovery from these diseases.
&&url PMID: 10094108  

<b>Reversible thyroid dysfunction during treatment with GM-CSF.</b>
To investigate whether autoimmunity against thyroid antigens is induced or exacerbated by granulocyte-macrophage colony-stimulating factor, thyroid function and thyroid autoantibodies were studied in 14 patients with advanced breast cancer and 11 with soft-tissue sarcoma who received several cycles of doxorubicin and cyclophosphamide plus GM-CSF ... All patients had normal thyroid function before treatment. In 2 patients with pre-existing thyroid antibodies, thyroid dysfunction developed but disappeared after cessation of GM-CSF. No other autoimmune abnormalities appeared. Stimulation of antigen-presenting cells by GM-CSF may bring about this phenomenon.
&&url PMID: 1678803 

<b>High-dose radiation and the emergence of thyroid nodular disease.</b>
High-dose radiation (in excess of 2500 rads or centiGray) to the head and neck area is reputedly infrequently associated with the emergence of thyroid nodular disease. Thirty-three patients who underwent high-dose radiation and who developed thyroid nodular disease have been described....Consideration of radiation beam behavior showed that isodose curve, penumbra effect, back scatter, and special field resulted in the thyroid gland receiving a low dose, namely under 2500 rads.... It is apparent that for whatever reason and by whatever means and by whatever mechanism, high-dose radiation to the head and neck area can result in significant thyroid disease, and patients undergoing such radiation should be followed with this in mind...
&&url PMID: 6505971 

<b>Thyroid carcinoma after successful treatment of osteosarcoma: a report of three patients.</b>
We report three cases of papillary thyroid carcinoma occurring after successful treatment of osteosarcoma. Only one of the three patients received radiation therapy (to the chest) as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred between 8 and 16 years from the cessation of osteosarcoma therapy. All patients are alive and disease-free from both malignancies. Whereas the association between osteosarcoma and thyroid carcinoma has not previously been recognized, there have been five case reports of these two entities occurring in the same patient. Three of these cases occurred in patients with Werner syndrome. None of the patients reported here had physical stigmata of Werner syndrome or a family history consistent with a hereditary cancer syndrome. Thyroid carcinoma occurs infrequently in patients with osteosarcoma, but in view of the rarity of these two disorders, this association may represent an inherited predisposition to these malignancies.
&&url PMID: 11464990  

            
<b>Sarcoma and thyroid disorders: a common etiology?</b>
We have recently observed that many of our sarcoma patients presented also with thyroid disorders. Literature data are almost unavailable on this topic. The relationship between the sarcoma and thyroid disorders is examined. Retrospective analysis of files of patients with sarcoma and clinically overt thyroid disorders was carried out. Of the 375 patients with soft tissue sarcomas (STS) and 235 with bone sarcoma (BS) ,,,(4.6%) had an associated significant thyroid disorder. The types of sarcoma were mainly liposarcoma followed by malignant fibrous histiocytoma, leiomyosarcoma and bone sarcoma. The primary sites were mainly limb and trunk. The interval between the diagnosis of the thyroid disorder and the sarcoma varied between -14 years (thyroid first) and +16.5 years (thyroid later) with a median of -0.2 years.  Thyroid disorders included goiter, thyroiditis and carcinoma. 

There are both basic-science and clinical evidence to a possible common pathway that leads to the association between overt thyroid disorders and sarcomas of bone or soft tissues. Oncogene erbA activity is related to thyroid receptors to T3 and to development of sarcoma. Cross talk of the sarcoma oncogene and the erbA might contribute to the development of sarcoma. The thyroid hormone receptor and the highly related viral oncoprotein v-erbA are found exclusively in the nucleus as stable constituents of chromatin. It has been shown that v-erbA can block the spontaneous differentiation in erythroid cells transformed by various retroviral oncogenes. V-erbA can alter the spectrum of neoplasia induced by the v-src oncogene, which 
causes predominantly sarcomas and erythroblastosis in chicks. The erbA can cooperate with other oncogenes such as v-erbB or with v-fms, v-ras, and c-kit. Cooperation with v-myc may play a role in the development of rhabdomyosarcoma especially in thyroid hormone deficiency state. 

The possible clinical implications are the need to screen patients with sarcoma to thyroid disorders, and patients with thyroid disorders for malignant diseases.
&&url PMID: 12066223
<b>The entire article for Sarcoma and thyroid disorders: A common etiology? Is at:</b>
&&url


compiled by doctordee
August 2005
