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

Abstract

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.

Fixed Dose Combination of Mecobalamin and Pregabalin in the Treatment of Orofacial Neuropathic Pain

“…15,16 In the second case, ionizing radiation ( 131 I) discharges high-energy gamma radiation 17 and influences adjacent non-malignant cells by release cytokines and inflammatory mediators. 18 The inflammatory response can lead fibrosis, atrophy, and ulceration of the tissues, including nerves, 19 ischemia, oxidative stress 20 and therefore nerve damage may develop. 19 Oxidative stress might influence the thyroid by degrade ordinary T3 to set reverse T3 and impedes the activity of T3 as the powerful neurotrophic substance.…”

Germline polymorphisms of the NOD2 pathway may predict the effectiveness of radioiodine in differentiated thyroid cancer treatment

“…It may manifest through direct signaling pathways, indirect modulation of cellular stress responses, or exacerbation of inflammatory processes [57]. RAI therapy in patients with DTC may increase proliferative lymphocyte responses and interferon-γ levels, demonstrating its proinflammatory function [58,59].…”