The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with thyroid gland complications following radiation and chemotherapy. The dysfunction may be due to primary dysfunction of the thyroid gland or else decreased stimulation from the hypothalamic-pituitary axis.
Subjective measures:
(1) metabolic
(2) gastrointestinal
(3) weight
(4) skin texture
(5) energy level
Objective measures:
(1) facies
(2) speech quality
(3) skin temperature
(4) hair texture
(5) nodules
(6) heart rate
Management measures:
(1) for all symptoms
(2) nodules
Analytic studies:
(1) basal T4: normal (Grade 1); 1-50% decrease (Grade 2); > 50% decrease (Grade 3)
(2) basal TSH: increased in primary thyroid dysfunction; decreased in hypothalamic-pituitary dysfunction
(3) stimulated TSH: can be used to assess thyroid responsiveness in primary thyroid dysfunction; can be used to assess the hypothalamic-pituitary axis in hypothalamic-pituitary dysfunction.
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
|
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
metabolic |
occasional chilliness |
intermittent chilliness |
needs supplemental heat |
NA |
|
gastrointestinal |
occasional constipation |
intermittent constipation |
persistent constipation |
NA |
|
weight |
>= 5% gain if hypothalamic-pituitary |
< 10% if primary thyroid |
>= 10% if primary thyroid |
NA |
|
skin texture |
NA |
intermittent sensation of dryness |
persistent sensation of dryness |
NA |
|
energy level |
occasional fatigue |
intermittent fatigue |
persistent fatigue |
NA |
|
facies |
NA |
barely noticeable |
obvious puffiness, thickened lips |
NA |
|
speech quality |
NA |
barely noticeable hoarseness and slowed speech |
obvious hoarseness and slowed speech |
NA |
|
skin temperature |
NA |
cool |
cold |
NA |
|
hair texture |
NA |
difficult to comb |
brittle, splitting, hair loss |
NA |
|
nodules |
NA |
NA |
NA |
palpable |
|
heart rate |
NA |
NA |
slowed |
NA |
|
management of symptoms |
NA |
thyroid replacement therapy |
|
NA |
|
management of nodules |
NA |
|
surgical or radionuclide therapy |
NA |
total score =
= SUM(points for all 13 items)
LENT score =
= (total score) / 13
Interpretation:
• maximum total score: 39
• minimum LENT score: 0
• maximum LENT score: 3
Specialty: Hematology Oncology, Endocrinology
