Temporary Ovarian Failure in Thyroid Cancer Patients after Thyroid Remnant Ablation with Radioactive Iodine

Raymond, J; Izembart, M; Marliac, V.; Dagousset, F.; Merceron, R E; Vulpillat, M.; Vallée, G

doi:10.1210/jcem-69-1-186

Cited by 88 publications

(72 citation statements)

References 3 publications

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“…In contrast, not all investigators have confirmed the benefit of adjuvant therapy with 131 I in this group (2), with this therapy resulting in 2 relevant problems, the need for iatrogenic hypothyroidism (11) and radioiodine toxicity (1,(3)(4)(5)(6)(7)(8)(9)(10). With respect to the latter, a low activity (1.1-1.85 GBq ) is applied to minimize the adverse effects of radioiodine.…”

Section: Discussionmentioning

confidence: 99%

“…Using MIRD (38), the estimated radiation in testes and ovaries would be 85 mGy and 140 mGy, respectively, when 3,700 MBq (100 mCi) of 131 I are administered during euthyroidism (as for the preparation with rhTSH). Specific studies on thyroidectomized patients during hypothyroidism suggest that the same activity would result in a testicular radiation of 86 mGy (39) to 120 mGy (40); the radiation in the ovaries would be much higher than estimated by MIRD (9), and an average radiation of 740 mGy would be obtained for the salivary glands (41). Interstudy comparison is inappropriate because of differences in the characteristics of the patients, in the preparation protocol, in the assessment techniques, and between examiners.…”

Section: Discussionmentioning

confidence: 99%

“…Factors against routine postoperative ablation are the uncertainty regarding the benefit for low-risk patients (2) and the undesired effects of this procedure. Rapidly occurring (weeks) and intense (low thyroxine) hypothyroidism has been inevitable until recently for ablation with 131 I, and although well tolerated, adverse effects of radioiodine, such as damage to the salivary glands (3)(4)(5), impaired gonadal function (6)(7)(8)(9), oxidative injury (10), and even the risk of a secondary neoplasm (1), have been documented. The consequences of iatrogenic hypothyroidism (11) and adverse effects of 131 I may equal or even exceed the eventual benefits of ablation, particularly in lowrisk patients (1,2,12).…”

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confidence: 99%

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Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity

Rosário¹,

Borges²,

Purisch³

2008

J Nucl Med

101

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Preparation with recombinant human thyroid-stimulating hormone (rhTSH) for thyroid remnant ablation results in lower extrathyroidal radiation than does hypothyroidism. The objective of this prospective study was to compare the damage caused by 131 I (3.7 GBq) when these 2 preparations are used. Methods: Ninety-four consecutive patients who underwent total thyroidectomy and remnant ablation with 3.7 GBq of 131 I were studied. Thirty patients (group A) received rhTSH, and 64 (group B) were prepared by levothyroxine withdrawal. Damage to salivary glands, ovaries, and testes; hematologic damage; and oxidative injury were evaluated by measurement of serum amylase, folliclestimulating hormone (FSH), complete blood count, and plasma 8-epi-PGF 2a before and after radioiodine. The 2 groups were similar in sex, age, and the results of baseline assessment. Results: The rate of successful ablation (stimulated thyroglobulin level , 1 ng/mL and negative findings on neck ultrasonography) was 90% in group A and 80% in group B. Considering only patients with a preablation thyroglobulin level greater than 1 ng/mL, these rates were 80% and 70.6%, respectively. Only 1 patient (3.3%) reported transient headaches with rhTSH. Elevated FSH levels after therapy were observed in 4 of 9 (44%) men in group A versus 16 of 18 (89%) in group B (P , 0.03), with a mean increase of 105% versus 236% (P , 0.001), respectively. In women, elevated FSH was observed in 1 of 13 (7.7%) patients in group A versus 6 of 30 (20%) in group B (P 5 0.4), with a mean increase of 65% versus 125% (P , 0.001). Thrombocytopenia or neutropenia occurred in 2 of 28 (7%) patients in group A versus 12 of 56 (21.4%) in group B (P 5 0.1), with a mean decrease of 20% versus 45% and 25% versus 52% (P , 0.01) for neutrophils and platelets, respectively. Hyperamylasemia and symptoms of acute sialoadenitis occurred in 11 of 30 (36.6%) versus 48 of 60 (80%) (P , 0.001) and in 9 of 30 (30%) versus 35 of 60 (58.3%) (P 5 0.01), respectively. 8-Epi-PGF 2a was found to be elevated after 131 I in 14 of 25 (56%) patients in group A versus 45 of 45 (100%) in group B (P , 0.001), with a mean increase of 60% versus 125% (P , 0.001). Conclusion: The lower radiotoxicity with rhTSH, suggested in dosimetry studies, was confirmed in the present prospective investigation, and this advantage occurred without compromising the efficacy of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity

Rosário¹,

Borges²,

Purisch³

2008

J Nucl Med

101

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“…Ovarian function is only temporarily compromised by radioiodine (2)(3)(4)(5), with permanent infertility being rare (2). Thus, many women with thyroid cancer treated with radioiodine may become pregnant, and it is therefore important to evaluate the evolution of these pregnancies and the consequences for the offspring.…”

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confidence: 99%

Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants

Rosário

Barroso

Rezende

et al. 2006

Arq Bras Endocrinol Metab

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Rationale: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring. Patients and methods: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy (3.7-5.5 GBq 131 I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception. Results: Four (5.1%) of the 78 pregnancies resulted in spontaneous abortions. Three (4%) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6% of the children (mean ± SD: 3350 ± 450 g) and only one infant (1.3%) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome. Conclusion: We conclude that pregnancies that occur 12 months after ablative therapy are safe. RESUMO Malformações na Prole de Mulheres com Câncer de Tireóide Tratadas com Radioiodo para Ablação de Remanescentes Tireoideanos.Arrazoado: Uma vez que a função ovariana está apenas temporariamente comprometida pela terapia com radioiodo, muitas mulheres com câncer de tireóide tratadas com radioiodo podem engravidar. O presente estudo avaliou a evolução dessas gravidezes e suas conseqüên-cias para a prole. Pacientes e métodos: Analisamos retrospectivamente 78 gravidezes de 66 mulheres submetidas a tiroidectomia total seguida de radioiodoterapia (3,7-5,5 GBq 131 I, média 4,64 GBq). Em todas, a concepção ocorreu um ano após a terapia ablativa (média de 30 meses). A idade variou de 19 a 36 anos (media de 30,6) à época do tratamento com radioiodo e de 23 a 39 anos (média de 32,8) na época da concepção. Resultados: Quatro (5,1%) das 78 gravidezes resultaram em abortamento espontâneo. Três (4%) dos 74 partos foram pré-termo, mas não houve nenhum natimorto. O peso ao nascer foi >2.500 g em 94,6% das crianças (média ± DP: 3.350 ± 450 g) e somente uma delas (1,3%) apresentou uma malformação aparente ao nascimento (comunicação intraventricular). Nenhuma diferença quanto à idade na época da radioiodoterapia ou na concepção ou na dose de radioiodo foi observada entre as gravidezes com ou sem um desfecho favorável. Conclusão: Gravidezes que ocorrem 12 meses após terapia ablativa com radioiodo são seguras.

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“…Amenorrhea due to temporary ovarian dysfunction (18,19) and depression of spermatogenesis (20) after radioiodine treatment have been observed.…”

Section: Discussionmentioning

confidence: 99%

Radioiodine therapy and subsequent pregnancy

Brandão

Miranda

Correa

et al. 2007

Arq Bras Endocrinol Metab

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Objectives: To evaluate abortion and fetal congenital anomaly rates in women previously submitted to radioiodine therapy for differentiated thyroid carcinoma. Study design: A case-control study of 108 pregnant women, 48 cases whose pregnancies were evaluated after they had undergone radioiodine therapy for differentiated thyroid carcinoma, and the control group consisted of 60 healthy pregnant women. Results: Of a total of 66 pregnancies, 14 conceived within the first year, 51 one or more years after the last administration of 131 I, the medical record of one patient was not available. The interval between the last radioiodine therapy administration and conception ranged from 1 month to 10 years. There were a total of 4 miscarriages, 2 of them for unknown reasons. There was one case of congenital anomaly and two preterms birth. Nine women presented the following pregnancy events: placental insufficiency, hypertensive crisis, placental detachment, risk of miscarriage, preterm labour and four miscarriages. No statistical difference was observed between the studied and control groups. Conclusion: Radioiodine was followed by no significant increase in untoward effects in neither the pregnancy nor the offspring. Objetivo: Avaliar a taxa de aborto e anomalia congênita em mulheres que engravidaram após radioiodoterapia para carcinoma diferenciado de tireóide. Pacientes e método: Estudo de caso controle com 108 mulheres, 48 submetidas à radioiodoterapia para carcinoma diferenciado de tireóide e 60 mulheres saudáveis (grupo controle). Resultados: De 66 gestações (grupo de pacientes que receberam radioiodo), 14 ocorreram no primeiro ano e 51 mais de um ano após a administração do 131 I. Não foi possível coletar dados de uma paciente. O intervalo entre a última dose de 131 I e a concepção variou de 1 mês a 10 anos. Ocorreram 4 abortos, 2 de causas desconhecidas. Houve 1 caso de anomalia congênita e 2 pretermos. Nove pacientes que receberam 131 I apresentaram intercorrências durante a gravidez: insuficiência placentária, crise hipertensiva, descolamento de placenta, ameaça de aborto, trabalho de parto prematuro e 4 abortos. Não houve diferença estatística entre o grupo estudado e o controle. Conclusão: O uso da radioiodoterapia para carcinoma diferenciado de tireóide em mulheres não foi relacionado com aumento de efeitos adversos nas mães e suas proles.

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Temporary Ovarian Failure in Thyroid Cancer Patients after Thyroid Remnant Ablation with Radioactive Iodine

Cited by 88 publications

References 3 publications

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity

Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants

Radioiodine therapy and subsequent pregnancy

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Temporary Ovarian Failure in Thyroid Cancer Patients after Thyroid Remnant Ablation with Radioactive Iodine

Cited by 88 publications

References 3 publications

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with 131I Is Associated with Lowered Radiotoxicity

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with 131I Is Associated with Lowered Radiotoxicity

Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants

Radioiodine therapy and subsequent pregnancy

Contact Info

Product

Resources

About

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity

Preparation with Recombinant Human Thyroid-Stimulating Hormone for Thyroid Remnant Ablation with ¹³¹I Is Associated with Lowered Radiotoxicity