Cardiovascular Effects of Cumulative Doses of Radioiodine in Differentiated Thyroid Cancer Patients with Type 2 Diabetes Mellitus

Dikbaş

The European Research Journal

et al. 2023

Objectives: Despite strong evidence regarding the impact of radioactive iodine (RAI) on the hematopoietic, genitourinary, and gastrointestinal systems, its role in the cardiovascular system needs to be clarified. We hypothesized that the presence of a presystolic wave could be predictive for cardiovascular dysfunction in subjects receiving RAI. Thus, we investigated presystolic wave presence in differentiated thyroid cancer (DTC) patients with and without RAI therapy after undergoing total thyroidectomy. Methods: Patients were included in the study within 1-5 years after thyroidectomy or thyroidectomy and RAI treatment. Participants were divided into three groups as follows: the first group included patients with DTC who received RAI following total thyroidectomy (Group 1; n = 33), the second group included patients with DTC who did not receive RAI following total thyroidectomy (Group 2; n = 34). The third group of age-matched subjects who underwent total thyroidectomy with suspicion of DTC and resulted in benign pathologies was also selected (Group 3; n = 37). All subjects underwent transthoracic echocardiography. The presence of a presystolic wave was assessed with Doppler imaging of the left ventricular outflow tract. Results: Presystolic wave was more common in subjects receiving RAI (Group 1) compared to Group 2 (those without RAI) (90.9% vs. 61.8% respectively, p = 0.003), and its prevalence in Group 3 was 54.1%. Multiple logistic regression analysis revealed that receiving RAI (OR: 4.922, 95% CI: 1.640 – 20.022, p = 0.004) was independently associated with a 5-fold higher risk for the presence of a presystolic wave. Conclusions: RAI following total thyroidectomy in patients with DTC is associated with a five-fold increase in the presence of the presystolic wave, as a proxy marker for subclinical left ventricular dysfunction.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The impact of radioactive iodine treatment on subclinical left ventricular dysfunction in patients treated for differentiated thyroid cancer: assessing the predictive value of presystolic wave

Dikbaş

The European Research Journal

et al. 2023

“…Recent studies have shed light on the cardiovascular implications of cumulative radioiodine doses in individuals with DTC, particularly those with concurrent T2DM. One study highlighted the differential cardiovascular effects of elevated total doses of 131I in people with DTC with and without T2DM, underscoring the need for tailored therapeutic approaches in this patient population [8].…”

Section: Discussionmentioning

confidence: 99%

“…Another investigation delved into the inflammatory response to radioiodine therapy in women, revealing that the interplay between neutrophils and obesity might limit 131I uptake, suggesting a complex association between prescribed radioiodine activity, blood radioactivity, BMI, and inflammatory markers in patients with both DTC and T2DM [9]. Further research explored the role of peripheral circulating free DNA and the platelet-to-lymphocyte ratio in individuals undergoing radioiodine therapy, indicating potential biomarkers for assessing therapy outcomes in this unique cohort [10].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Implications of Cumulative Radioiodine Doses in Patients With Differentiated Thyroid Cancer and Type 2 Diabetes Mellitus, Bihar, India: A Retrospective Study.

Ahsan,

Roshan,

Raza

et al.

Background:The study aims to investigate the cardiovascular effects associated with cumulative doses of radioiodine therapy in people diagnosed with differentiated thyroid cancer (DTC) and comorbid Type 2 diabetes mellitus, with a focus on elucidating potential risks and outcomes for this patient population. Methods:A retrospective cohort study was conducted, enrolling 75 female participants categorized into DTC/−T2DM (Category I) and DTC/+T2DM (Category II). Data on demographic characteristics, radioiodine therapy, cardiovascular outcomes, and clinical parameters were collected from medical records. Statistical analyses were accomplished using SPSS software ver. 18. Results:Patients with DTC and without T2DM (DTC/−T2DM) exhibited higher average age (60 ± 6.3 years) and BMI (28.5 kg/m²) compared to patients with both DTC and T2DM (55 ± 5.2 years, 25.1 kg/m²). Patients with both DTC and T2DM received higher cumulative doses of radioiodine (200 mCi ± 25) over a longer duration (14 months) compared to patients with DTC and without T2DM (180 mCi ± 20, 12 months). The prevalence of hypertension, arrhythmias, and myocardial infarctions was higher in patients with DTC and without T2DM than in patients with both DTC and T2DM. Statistical analysis revealed significant variations in hypertension incidence (p < 0.001) and myocardial infarction occurrence (p = 0.03) between the groups. Multivariate regression analysis showed an independent association of T2DM with a higher risk of hypertension (p < 0.001) and myocardial infarction (p = 0.015) among DTC patients. Conclusion:The study highlights the importance of considering cardiovascular risks associated with radioiodine therapy in DTC patients, particularly those with T2DM. Personalized treatment strategies balancing cancer management and cardiovascular risk mitigation are crucial for optimizing patient outcomes. Recommendations:Clinicians should adopt a multidisciplinary approach integrating endocrinology, oncology, and cardiology to optimize the management of DTC patients with T2DM.

Portrait of the Inflammatory Response to Radioiodine Therapy in Female Patients with Differentiated Thyroid Cancer with/without Type 2 Diabetes Mellitus

Stanciu

Hurduc

Stanciu

et al. 2023

Cancers

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No clinical studies have investigated the effect of radioiodine (131I)-targeted therapy on the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as inflammatory response markers in patients with differentiated thyroid cancer (DTC) associated with type 2 diabetes mellitus (T2DM) and obesity. This study aimed to assess the relationship between blood radioactivity, body mass index (BMI), and peripheral blood cells three days after 131I intake in 56 female patients without T2DM (DTC/−T2DM) vs. 24 female patients with T2DM (DTC/+T2DM). Blood radioactivity, measured three days after 131I intake, was significantly lower in the DTC/+T2DM than in the DTC/−T2DM patients (0.7 mCi vs. 1.5 mCi, p < 0.001). The relationship between blood radioactivity and BMI (r = 0.83, p < 0.001), blood radioactivity and NLR (r = 0.53, p = 0.008), and BMI and NLR (r = 0.58, p = 0.003) indicates a possible connection between the bloodstream 131I uptake and T2DM-specific chronic inflammation. In patients without T2DM, 131I therapy has immunosuppressive effects, leading to increased NLR (19.6%, p = 0.009) and PLR (39.1%, p = 0.002). On the contrary, in the chronic inflammation context of T2DM, 131I therapy amplifies immune metabolism, leading to a drop in NLR (10%, p = 0.032) and PLR (13.4%, p = 0.021). Our results show that, in DTC/+T2DM, the bidirectional crosstalk between neutrophils and obesity may limit 131I uptake in the bloodstream. Considering the immune response to 131I therapy, the two groups of patients can be seen as a synchronous portrait of two sides. The explanation could lie in the different radiosensitivity of T and B lymphocytes, with T lymphocytes being predominant in patients with DTC/−T2DM and, most likely, B lymphocytes being predominant in T2DM.