Association between radioiodine treatment for thyroid cancer and risk of stroke

Lin, Chun-Yi; Lin, Cheng‐Li; Lo, Yi‐Chen; Kao, Chia‐Hung

doi:10.1002/hed.24903

Cited by 7 publications

(10 citation statements)

References 34 publications

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“…The relationship between RAI, carotid intima thickness, and subsequent atherosclerosis in thyroid cancer patients is still controversial. In our study, RAI was not associated with a higher risk of cerebrovascular disease (HR = 1.04, 95% CI = 0.74-1.20, p = 0.91), which is consistent with the established literature [25].…”

Section: Discussionsupporting

confidence: 92%

Radioactive Iodine Treatment and the Risk of Long-Term Cardiovascular Morbidity and Mortality in Thyroid Cancer Patients: A Nationwide Cohort Study

Kao

Chung

Chien

et al. 2021

JCM

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(1) Background: This study aimed to investigate the association between radioactive iodine (RAI) and long-term cardiovascular disease (CVD) morbidity/mortality in thyroid cancer. (2) Methods: The study was conducted using data from the Taiwan National Health Insurance Database during 2000–2015. Thyroid cancer patients aged ≥20 years were categorized into RAI (thyroidectomy with RAI) and non-RAI (thyroidectomy only) groups. The Cox proportional hazard regression model and Kaplan–Meier method were used for analysis. (3) Results: A total of 13,310 patients were included. Kaplan–Meier analysis demonstrated that the two groups had similar cumulative risks of CVD (log-rank p = 0.72) and CVD-specific mortality (log-rank p = 0.62). On Cox regression analysis of different RAI doses, the risk of CVD was higher in the cumulative dosage >3.7 GBq (hazard ratio = 1.69, 95% confidence interval = 1.24–2.40, p < 0.001). (4) Conclusions: RAI was not associated with an increased risk of CVD in thyroid cancer. However, CVD surveillance is indicated in the patients receiving the cumulative RAI dosage above 3.7 GBq.

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Section: Discussionsupporting

confidence: 92%

Radioactive Iodine Treatment and the Risk of Long-Term Cardiovascular Morbidity and Mortality in Thyroid Cancer Patients: A Nationwide Cohort Study

Kao

Chung

Chien

et al. 2021

JCM

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“…We also postulate baseline patient age, extent of residual thyroid tissue as well as differences in underlying disease contribute discrepancy between two studies. Another recent nationwide cohort study with a 10-year follow-up from Taiwan (24) reported an HR of 0.89 (95% CI, 0.60-1.33) after adjustments for age, sex, and comorbidities, suggesting that 131 I treatment for TC did not increase the risk of stroke. These discrepancies are likely due to the studies' different underlying thyroid diseases, population parameters, and design; therefore, the inconsistent findings concerning higher cerebrovascular disease risk at lower cumulative RAI dosage and no increase risk at higher cumulative RAI dosage requires standardized international studies to acquire definite conclusions.…”

Section: Discussionmentioning

confidence: 97%

“…In multivariate analyses after adjustments, the HR for cerebrovascular events was 1.17 (95% CI, 1.07-1.28) in hyperthyroid patients and 1.21 (95% CI, 1.02-1.44) in euthyroid patients. It should be noted, however, that the actual values of thyroid stimulating hormone (TSH), which are important discriminative factors between RAItreated patients and controls for cerebrovascular events, were not included in this study, and the median total dosage of RAI therapy (approximately 11 mCi) was relatively low compared to that used in other studies of patients with TC (9,24). We also postulate baseline patient age, extent of residual thyroid tissue as well as differences in underlying disease contribute discrepancy between two studies.…”

Section: Discussionmentioning

confidence: 99%

Effects of radioactive iodine treatment on cardiovascular disease in thyroid cancer patients: a nationwide cohort study

Kim¹,

Song²,

Kim³

et al. 2020

Ann Transl Med

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Background: Radioactive iodine (RAI) treatment is a standard treatment in differentiated thyroid cancer (TC). However, its adverse effects on cardiovascular diseases (CVDs) have not been clearly elucidated. Methods:In this retrospective cohort study based on the Korean National Health Insurance Service-National Health Screening Cohort (2002Cohort ( -2015, we analyzed 4,845 patients with TC with a median followup of 66 months. We evaluated and compared the risk of CVD between patients treated with and without RAI therapy. The primary CVD outcome was defined as a composite of ischemic stroke (IS), ischemic heart disease (IHD), hemorrhagic stroke (HS), or heart failure (HF).Results: Overall, 2,533 patients (52.3%) received RAI treatment with a median cumulative dosage of 103 mCi [interquartile range (IQR), 40-162 mCi]. The incidence of the primary CVD outcome in patients who did not receive RAI therapy and those who did was 17.32 [95% confidence interval (CI), 15.07-19.90] and 13.96 (95% CI, 12.17-16.01) per 1,000 person-years, respectively, indicating an adjusted hazard ratio (HR) of 0.87 (95% CI, 0.71-1.07) after multivariate adjustments for variable confounding factors. The risks of IS (HR, 0.83; 95% CI, 0.51-1.34), IHD (HR, 0.90; 95% CI, 0.71-1.13), HS (HR 1.01; 95% CI, 0.49-2.09), and HF (HR 0.89; 95% CI, 0.49-1.63) were comparable between the patients who received RAI therapy and those who did not. There was no cumulative dose-dependent risk for CVD in TC patients who received RAI treatment.Conclusions: RAI treatment is a prevalent and crucial treatment for TC, and has been used in more than half of TC patients in Korea from 2004 to 2015. This study found no significant between-group difference for the CVD risk in patients with TC who received RAI treatment and those who did not, giving further evidence to allay concerns related to the adverse effects of RAI.

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“…Endogenously suppressed TSH was found to be associated with cardiovascular morbidity and mortality in the general population [8,9] . The findings of elevated atherosclerotic cardiovascular risk factors as well as cardiovascular morbidity among TC patients also highlight the importance of a balance between benefits and detriments when considering exogenous TSH suppression for TC patients [26,27,33] . The extent of TSH suppression has also been questioned by others [44] .…”

Section: Discussionmentioning

confidence: 99%

“…Several pathological and high-risk conditions have been found among individuals with TC in comparison to the healthy controls. Park et al [33] investigated the relationship of potential risk factors and treatment effects with cardiovascular disease outcome among 3822 TC survivors, using the state-wide Utah Population Database during a mean 8.4-year follow-up. They found a significant association between the following factors and a high risk of cardiovascular conditions: age at diagnosis (40- Izkhakov et al [28] likewise reported an elevated risk for cardiovascular morbidity among DTC survivors aged 55-64 (HR = 1.29 [1.08-1.53]) and 65-74 years (HR = 1.36 [1.14-1.61]) compared to matched controls.…”

Section: Associations Between Potential Cardiovascular Risk Factors and Cardiovascular/cerebrovascular Morbidity Among Tc Survivorsmentioning

confidence: 99%

Cardiovascular morbidity and mortality as a confounder of prognosis in thyroid cancer

Izkhakov¹,

Keinan‐Boker²,

Stern³

2021

JCMT

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Thyroid cancer (TC) constitutes more than 95% of all endocrine tumors. Differentiated thyroid carcinoma (DTC), which includes the papillary and follicular types, constitutes about 90% of all TCs and 2.1% of all cancers. The incidence of DTC has increased significantly worldwide, with papillary cancer leading this trend and being the most prevalent. Whereas the prognosis of patients with DTC is generally favorable, with the overall 5-year survival rate reaching up to 95%, long-term follow-up also discloses increased propensity for cardiovascular and cerebrovascular risk factors, morbidity, and mortality. Cardiovascular events are linked to TC particularly in subjects aged 45 years or more. The present review and analysis seek to highlight the significance of cardiovascular disease in the overall prognosis among TC survivors and explore potential mechanisms which might link treatment choices in DTC to cardiovascular risk and disease outcome.

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Association between radioiodine treatment for thyroid cancer and risk of stroke

Abstract: The I-131 treatment for thyroid cancer did not increase the risk of stroke during 10-year follow-up.

Cited by 7 publications

References 34 publications

Radioactive Iodine Treatment and the Risk of Long-Term Cardiovascular Morbidity and Mortality in Thyroid Cancer Patients: A Nationwide Cohort Study

Radioactive Iodine Treatment and the Risk of Long-Term Cardiovascular Morbidity and Mortality in Thyroid Cancer Patients: A Nationwide Cohort Study

Effects of radioactive iodine treatment on cardiovascular disease in thyroid cancer patients: a nationwide cohort study

Cardiovascular morbidity and mortality as a confounder of prognosis in thyroid cancer

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