I-131 remnant ablation after thyroidectomy induced hepatotoxicity in a case of thyroid cancer

Abstract

BackgroundRadioactive iodine (I-131) is routinely used for the treatment of differentiated thyroid cancer following surgery. Drug-induced liver injury (DILI) is a leading cause of acute liver failure. Here we reported a rare case of diffuse hepatic uptake (DHU) of radioactive iodine (I-131) induced hepatotoxicity in patient with I-131 ablation therapy after thyroidectomy.Case presentationA 57-year-old woman was admitted due to jaundice, itching and dark urine with abnormally elevated liver function. She has performed thyroidectomy followed by 100mci radioactive I-131 ablation therapy 21 days ago. The basic hepatic protection could not efficiently prevent disease progression. The patient was further treated with methylprednisolone, the bilirubin and alanin aminotransferase were finally lowered back to normal in the follow-up visit.ConclusionTo the best of our knowledge, this is the rare description of DILI complications in thyroidectomy patient due to I-131 ablation therapy. The patient responds to glucocorticoid therapy well, but not basic hepatic protection treatment. Even though this is only a single case, it reminds physicians make DILI in early consideration when patient present liver injury after I-131 ablation therapy.

Drug-induced liver injury caused by iodine-131

“…Few previous studies have reported on DILI after iodine-131 therapy. Lin et al [ 4 ] reported hepatotoxicity after iodine-131 therapy in a patient with thyroid cancer who subsequently responded to methylprednisolone. Another report described two cases of liver toxicity after iodine-131 ablation therapy in two patients with Grave’s disease, both of whom were treated with prednisolone [ 5 ].…”

“…Conventional doses of iodine-131 are 75–100 millicurie (mCi; 2,775–3,700 millibecquerel) [ 3 ]. Few case reports have found that iodine-131 induced liver injury, including a case report involving a patient with Grave’s disease [ 4 , 5 ]. Here we present a case of drug-induced liver injury (DILI) that occurred 10 days after iodine-131 ablative therapy and responded favorably to oral corticosteroid.…”

Effect of Predictive Nursing Intervention on the Gastrointestinal Side Effects of I-131 Re-treatment in Patients with Differentiated Thyroid Cancer (DTC)

“…However, I-131 tends to accumulate in the stomach as it is orally administered and excreted by the urinary system [6]. Unfortunately, I-131 causes the destruction of thyroid cells through beta particles after the radioiodine is absorbed by the body fluids [7][8][9].…”

“…In I-131 treatment, the dosage prescribed for thyroid cancer is approximately 3,000 MBq, and the dosage may be increased to 8,000 MBq in patients with metastatic lesions [7][8][9]. As for patients are injected with large amounts of I-131, patients may have gastrointestinal adverse effects, including dose-dependent, presenting as nausea, anorexia, and vomiting [10,11].…”

Ameliorating effects of N-acetyl cysteine against early liver damage of radioiodine in rats

“…In animal studies, it has been shown that RAIT caused significant morphological damage to rat livers in both short and long-term period of treatment [9,10]. It has been observed that the high dose RAI ablation therapy as 75–150 mCi might lead to drug-induced liver injury (DILI) in the thyroidectomized patient [11]. Liver toxicity has been reported even after low dose (5–10 mCi) 131 I treatment in two patients with Graves’ disease by Jhummon et al .…”