{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:24:50Z","timestamp":1792808690512,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thyroid function abnormalities can occur after treatment for childhood cancer. Evidence for the management of thyroid dysfunction among asymptomatic childhood cancer survivors (CCS) is lacking. We used a Delphi consensus methodology to expand guidelines for screening asymptomatic CCS at risk for thyroid dysfunction and explore recommendations for the clinical management of abnormal results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A Delphi panel of 40 expert physicians representing oncology, endocrinology, and primary care participated in three rounds of anonymous, iterative questionnaires formatted as clinical scenarios. Consensus is defined as \u2265 90% of panelists agree with recommendation and disagreement as &lt; 70% agree.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Panelists reached consensus that CCS treated with radiation including neck, total body, whole brain, brain including the hypothalamic\u2010pituitary axis (HPA), and therapeutic meta\u2010iodobenzylguanidine (MIBG) should have annual, lifelong screening using serum thyroid\u2010stimulating hormone (TSH) and free T4 starting within one year off\u2010treatment (98%). Panelists disagreed on continuing to screen CCS for thyroid dysfunction after immunotherapy associated with acute thyroid injury (31%\u201050%). There was also disagreement on indications for brain (17%\u201043%) or thyroid (50%\u201065%) imaging, laboratory tests to assess the HPA (29%\u201075%), and TSH threshold to initiate treatment of subclinical hypothyroidism. Lack of evidence was the most frequent rationale panelists offered for not recommending additional testing or medications. Panelists\u2019 recommendations did not vary by geography, specialty, or survivorship clinical experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Consensus was reached on most recommendations for screening and management of cancer treatment\u2010related thyroid dysfunction. Screening after completion of thyroid\u2010toxic immunotherapy, indications for imaging, and treatment of subclinical hypothyroidism are areas of disagreement for further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29942","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T13:04:45Z","timestamp":1662555885000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Management of childhood cancer survivors at risk for thyroid function abnormalities: A Delphi study"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9117-4812","authenticated-orcid":false,"given":"Jennifer J.G.","family":"Welch","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Hasbro Children's Hospital Warren Alpert Medical School of Brown University  Providence Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Ames","sequence":"additional","affiliation":[{"name":"General Academic Pediatrics, Dartmouth\u2010Hitchcock Medical Center, New Hampshire  Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie E.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Diabetes Children's Hospital at Montefiore  Bronx New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Gaufberg","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Dana\u2010Farber Boston Children's Cancer and Blood Disorders Center  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Hudson","sequence":"additional","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital  Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-0871","authenticated-orcid":false,"given":"Paul C.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Nekhlyudov","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham Women's Hospital Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6408-8011","authenticated-orcid":false,"given":"Torunn I.","family":"Yock","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Massachusetts General Hospital Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wassim","family":"Chemaitilly","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2407-2522","authenticated-orcid":false,"given":"Lisa B.","family":"Kenney","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Dana\u2010Farber Boston Children's Cancer and Blood Disorders Center  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2017.76.3268"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1667\/rr14888.1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33969"},{"key":"e_1_2_8_5_1","unstructured":"Children's Oncology Group.Long\u2010term follow\u2010up guidelines for survivors of childhood adolescent and young adult cancers version 5.0 Monrovia CA: Children's Oncolgoy Group; 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