Thyroid-Associated Ophthalmopathy after Radioactive Iodine Therapy for Metastatic Follicular Thyroid Carcinoma

Murayama, Daisuke; Toda, Soji; Okubo, Yoichiro; Hayashi, Hiroyuki; Matsui, Ai; Yasukawa, Mio; Iwasaki, H.

doi:10.1155/2021/3024639

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…Surgical resection following lenvatinib therapy has been reported 12–14 . However, thyroid cancer surgery following lenvatinib therapy is limited 15 . In this study, we identified ischaemic changes in PTC and FTC specimens probably due to inhibition of angiogenesis, a key effect of lenvatinib 7 .…”

Section: Discussionmentioning

confidence: 79%

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Histological findings of thyroid cancer after lenvatinib therapy

Okubo,

Toda,

Sato

et al. 2023

Histopathology

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AimsLenvatinib is a multikinase inhibitor used for treating unresectable or metastatic cancers, including thyroid cancer. As total thyroidectomy followed by radioactive iodine therapy is a commonly recommended initial treatment for thyroid cancer, histological findings of the thyroid after lenvatinib therapy remain unclear. Therefore, the aim of this study was to analyse in‐vivo changes in patients who underwent thyroidectomy after lenvatinib therapy.Methods and resultsWe screened 167 patients with thyroid cancer [papillary thyroid cancer (PTC), n = 102; follicular thyroid cancer (FTC), n = 26; anaplastic thyroid cancer (ATC), n = 39] who underwent lenvatinib therapy. Among these patients, six underwent thyroidectomy (lenvatinib‐treated group: PTC, n = 3; FTC, n = 1; ATC, n = 2), and the specimens were examined. Five patients with PTC who did not receive lenvatinib therapy were included for comparison (untreated group). Microvessel density (MVD) was evaluated in both groups. The PTC and FTC specimens showed relatively more ischaemic changes than ATC specimens. Coagulative necrosis and ischaemic changes in cancer cells were frequently observed. ATC specimens showed fibrosis and mild cell damage. As hypothyroidism is a common side effect of lenvatinib therapy, non‐cancerous thyroid tissues were also examined. Histological findings included mild lymphocytic infiltration, lymphoid follicular formation, histiocytic reaction and follicular epithelial destruction. The MVD in lenvatinib‐treated tissues was significantly lower than that in untreated tissues.ConclusionsLenvatinib therapy probably induces relatively specific ischaemic changes in thyroid cancer cells. Moreover, inflammatory cell infiltration and decreased MVD occur to varying degrees in non‐cancerous thyroid tissue and may be related to hypothyroidism, a side effect of lenvatinib.

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Section: Discussionmentioning

confidence: 79%

“…[12][13][14] However, thyroid cancer surgery following lenvatinib therapy is limited. 15 In this study, we identified ischaemic changes in PTC and FTC specimens probably due to inhibition of angiogenesis, a key effect of lenvatinib. 7 Coagulative necrosis was observed around the central lesions in cases 1, 2 and 4.…”

Section: Discussionmentioning

confidence: 82%

Histological findings of thyroid cancer after lenvatinib therapy

Okubo,

Toda,

Sato

et al. 2023

Histopathology

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“…6 However, few studies have considered GO occurrence after thyroidectomy in people without GD. There are limited reports of euthyroid GO's association with thyroid cancer, [7][8][9] and its pathogenesis remains unclear. Despite this, previous studies have observed GO symptom improvement and exacerbation during thyroid cancer treatments, including surgery and RAI therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, previous studies have observed GO symptom improvement and exacerbation during thyroid cancer treatments, including surgery and RAI therapy. 9,10 Herein, we collected GO case reports associated with thyroid cancer and analyzed big data from the Korean National Sample Cohort. We delineated twelve cases pertinent to thyroid cancer without previous hyperthyroidism history, divided thyroid cancer patients into two groups relative to GO diagnoses, and compared potential factors affecting GO development.…”

Section: Introductionmentioning

confidence: 99%

Graves’ orbitopathy development in thyroid cancer patients: A 16-year nationwide cohort study in South Korea

Lee,

Kim,

Lee

et al. 2023

Preprint

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Background/Objectives: Thyroid cancer patients, without history of hyperthyroid condition, suffer from Graves’ orbitopathy (GO). We investigated its incidence, possible risk factors and prognosis. Subjects/Methods: This study is a retrospective cohort study that analyzes medical records of 1,137,861 South Korean patients from 2002 to 2019. Those whom without hyperthyroidism or GO prior to thyroid cancer diagnosis were included. We investigated 8,499 individuals and compared the type of surgery, dose of radioactive iodine (RAI) and daily average thyroid hormone between GO group and non-GO group. In addition, each GO patient’s medical records were analyzed, and the course of disease and the type of treatment was described. Results Among 8,499 cancer patients, 7,836 cases received a thyroidectomy, and 12 were diagnosed with GO after surgery. None of the remaining 663 cases received a GO diagnosis. In addition, the GO group indicated a significantly higher total RAI dose average than the non-GO group (p = 0.036). Within the GO group, the approximate time from thyroid cancer diagnosis to GO occurrence was 460.5 (331.0-984.8) days. Five patients underwent RAI therapy before GO diagnosis. Of these, four expressed GO within a year post-RAI therapy, and the total iodine dose before GO was 168.5 (139.8-203.8) mCi. The average daily thyroid hormone dose before GO was 85 (70–120) µg. One case required intravenous and oral steroids Conclusions Although GO rarely develops in thyroid cancer patients without coexisting hyperthyroidism, the total RAI dose may increase its risk. Further study regarding its pathogenesis would help clarify GO’s association with thyroid cancer.

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Thyroid-Associated Ophthalmopathy after Radioactive Iodine Therapy for Metastatic Follicular Thyroid Carcinoma

Cited by 2 publications

References 12 publications

Histological findings of thyroid cancer after lenvatinib therapy

Histological findings of thyroid cancer after lenvatinib therapy

Graves’ orbitopathy development in thyroid cancer patients: A 16-year nationwide cohort study in South Korea

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