Iodine-131 Treatment of Thyroid Papillary Carcinoma in Patients Undergoing Dialysis for Chronic Renal Failure: A Dosimetric Method

Abstract

Until recently, the therapeutic protocol widely accepted for ablation of the thyroid remnant and for metastases of thyroid papillary carcinoma was the administration of 131I after surgery. However, at present, some data question the usefulness of such treatment in patients considered low risk. The treatment with radioiodine in patients suffering from end-stage renal disease (ESRD) undergoing hemodialysis requires controlled dosages and individualized administration guidelines. The need to include these patients on the waiting list for a renal transplantation, once they have overcome the disease, and the higher prevalence of thyroid carcinoma in ESRD patients makes this an increasingly significant problem. The cases reported in the literature are few and the therapeutic models followed are very difficult. In this paper we propose a therapeutic model that provides the highest thyroid ablative dosage, minimizing radiation exposure to the rest of the organs. The main difference between our protocol and that already described is the performance of daily hemodialysis during the first 5 days of treatment, as well as the administration of a dose of 131I equivalent to that administered to patients who show normal renal function.

Thyroid dysfunction and kidney disease

“…This effect could act as a compensatory mechanism to neutralize the thyroid dysfunction in order to maintain euthyroid status (129). Treatment with ablative dose of 131 I has been successfully used in the treatment of differentiated thyroid carcinoma in patients on HD (108,(130)(131)(132)(133)(134)(135)(136). HD removes more 131 I from blood than from thyroid and helps to reduce radiation (132).…”

Radiation protection procedures in 131I treatments for thyroid cancer in patients requiring hemodialysis

“…Other groups have proposed administering larger treatment activities due to rapid iodine clearance from dialysis [6,8]. Finally, a third view suggests that the dose should be the same [5,9]. The trend in our center is to reduce the 131 I activity.…”

Can radioiodine be administered effectively and safely to a patient with severe chronic kidney disease?

“…The aforementioned phenomena increase the risk of patients with CKD exceeding safe doses of I‐131. Studies on the radioactivity of the whole body have shown that radioactivity decreases by 50% within 24–48 h in patients with ESRD treated with I‐131 for differentiated thyroid cancer . HD increases I‐131 clearance, causing so‐called rapid I‐131 clearance, as opposed to the slow I‐131 clearance that depends on residual renal function.…”