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Cancer Treat Rev. 2015 Dec;41(10):925-34. doi: 10.1016/j.ctrv.2015.09.001. Epub 2015 Sep 10.

Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma--a systematic review.

Author information

1
Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.c.clement@amc.uva.nl.
2
Department of Internal Medicine/Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands; Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands.
3
Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
4
Department of Endocrinology, University Medical Center, University of Groningen, Groningen, The Netherlands.
5
Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
6
Department of Pediatric Surgery, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
7
Department of Radiology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
8
Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
9
Department of Internal Medicine/Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands.
10
Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
11
Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

BACKGROUND:

Treatment of differentiated thyroid carcinoma (DTC) often involves administration of radioactive iodine (I-131) for remnant ablation or adjuvant therapy. As DTC has favorable outcome and the incidence is increasing, concerns have been raised about the possible adverse effects of I-131 therapy. We systematically reviewed the literature to examine the risk of intermediate and long-term adverse effects of I-131 therapy in DTC patients.

METHODS:

Multiple electronic databases were searched up to November 2014 for English-language, controlled studies that reported on the risk of salivary gland dysfunction, lacrimal gland dysfunction, gonadal dysfunction, female reproductive outcomes or second primary malignancies (SPM) after I-131 exposure. The certainty of the evidence found was assessed using GRADE.

RESULTS:

In total, 37 articles met all inclusion criteria, no studies reporting on adverse effects after I-131 treatment focused solely on children. After exposure to I-131 for DTC, patients experienced significantly more frequently salivary gland dysfunction (prevalence range: 16-54%, moderate-level evidence), lacrimal gland dysfunction (prevalence: 11%, low-level evidence), transient male gonadal dysfunction (prevalence: 35-100%, high-level evidence), transient female gonadal dysfunction (prevalence: 28%, low-level evidence) and SPM (prevalence: 2.7-8.7%, moderate-level evidence) compared to unexposed patients. I-131 therapy seems to have no deleterious effects on female reproductive outcomes (very-low level evidence). The prevalence and severity of adverse effects were correlated to increasing cumulative I-131 activity.

CONCLUSION:

Treatment with I-131 for DTC may have significant adverse effects, which seem to be dose dependent. These adverse effects of treatment must be balanced when choosing for I-131 therapy in patients with DTC.

KEYWORDS:

Adverse effects; Complications; Differentiated thyroid carcinoma; I-131; Radioactive iodine; Second primary malignancies

PMID:
26421813
DOI:
10.1016/j.ctrv.2015.09.001
[Indexed for MEDLINE]

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