Radioprotective Agents for the Prevention of Side Effects Induced by Radioiodine-131 Therapy

Abstract

Radioiodine 131 ((131)I) has been used worldwide for the ablation of remnant thyroidal tissue after surgery or as the first-line treatment for Graves' disease. Although the use of (131)I is becoming increasingly prevalent, there is evidence suggesting that this treatment is associated with side effects such as salivary gland dysfunction and an increased risk of leukemia. This article aims to review the potential use of radioprotective agents and the side effects induced by (131)I therapy. Several synthetic and natural compounds have been investigated in preclinical and clinical studies. The protective agents reduced the toxicity of (131)I, mainly in the salivary glands, and mitigated the genetic damage through different mechanisms. There are limited clinical studies evaluating the use of radioprotective agents in patients undergoing radioiodine therapy. However, lemon candies, lemon juice and sugarless chewing gum have been proposed to be beneficial for minimizing the side effects of radioiodine within the salivary glands.

Resveratrol Sensitizes Selectively Thyroid Cancer Cell to 131-Iodine Toxicity

“…Patients suffer from these side effects. Pharmacological treatment can be a promising strategy for protecting patients from side effects induced by 131 I therapy [3]. Recently we showed RSV significantly protected human lymphocytes from genotoxicity induced by 131 I. RSV reduced micronuclei frequency in lymphocytes in combination with 131 I [21].…”

“…DNA damage and chromosomal breaks are main reasons for cell damage and death. Reactive oxygen species (ROS) are generated by 131 I [2, 3]; these toxic products can attack critical macromolecules, such as DNA, leading to cell damage and death [4, 5]. However, 131 I concentrates at high level in thyroid tissue with a high target to nontarget ratio which is perfect for thyroid cancer therapy; it has side effects, such as sialadenitis, haematological depression, xerostomia, and radiation thyroiditis [6–11].…”

Increased Risk of Leukemia After Radioactive Iodine Therapy in Patients with Thyroid Cancer: A Nationwide, Population-Based Study in Korea

“…of reactive oxygen species (27). Reactive oxygen species induce the peroxidation of lipids, which results in structural and functional damage to the cellular membrane, DNA strand breakage, and DNA base alterations (27,28). The frequency of micronuclei in the peripheral blood, which is an indicator of breaks in the chromosome, has been shown to increase as early as 2 days, peaks at 7 days, and slowly returns to the baseline frequency over 6-12 months after RAIT (29,30).…”

Interstitial Deletion of Chromosome 9q in Therapy-Related Acute Promyelocytic Leukemia with Pathognomonic t(15;17) in a Patient Exposed to Radioactive Iodine

“…A short period of post-RAI treatment surveillance may be reasonable if a causative relationship is established between RAI exposure and development of myeloid neoplasms. Recent clinical studies have also investigated the benefits of radioprotective agents, both synthetic and natural, in mitigating genetic damage in patients undergoing RAI therapy [20].…”