ABSTRACT
I-131 is the first most experienced theranostic radionuclide that has been used since the early 1940s for the treatment of hyperthyroidism, metastases or ablation of residual thyroid tissue in well-differentiated thyroid cancers. Although generally safe and very well tolerated, radioiodine therapy has some potential side effects classified as early and late complications. Early side effects include nausea, rarely vomiting, oral mucositis, sialadenitis, taste disturbance, gastrointestinal, gonadal and hematopoietic system dysfunction and radiation thyroiditis in the cases with large residual tissue. Late complications include secondary cancers, pulmonary fibrosis, and permanent bone marrow suppression. Early complications are generally due to the radioiodine activity and have transient nature, late complications are due to the cumulative radiation dose and are rare. The aim of this article is to review the potential side effects and complications of I-131 therapy and their clinical management.
References
1
Mazzaferri EL, Amdur RJ. Essentials of thyroid cancer management. Vol 129. Springer Science & Business Media, 2006.sayfa.267-279.
2
Van Nostrand D, Neutze J, Atkins F. Side effects of “rational dose” iodine-131 therapy for metastatic well-differentiated thyroid carcinoma. J Nucl Med 1986;27:1519-1527.
3
McCall M, Timm L, Frenkel E. CHEWING TOBACCO AND RADIOIODINE. The Lancet 1967;289:902.
4
MYANT NB. Iodine metabolism of salivary glands. Ann N Y Acad Sci 1960;85:208-214.
5
Mishkin FS. Radionuclide salivary gland imaging. Semin Nucl Med 1981;11:258-265.
6
Maier H, Bihl H. Effect of radioactive iodine therapy on parotid gland function. Acta Otolaryngol 1987;103:318-324.
7
Mason DK, Harden RM, Alexander WD. The salivary and thyroid glands. A comparative study in man. Br Dent J 1967;122:485-489.
8
Malpani BL, Samuel AM, Ray S. Quantification of salivary gland function in thyroid cancer patients treated with radioiodine. Int J Radiat Oncol Biol Phys 1996;35:535-540.
9
Mandel SJ, Mandel L. Radioactive iodine and the salivary glands. Thyroid 2003;13:265-271.
10
Albrecht HH, Creutzig H. Funktionsszintigraphie der Speicheldrüsen nach hochdosierter Radiojodtherapie. Laufender Titel: Speicheldrüsenszintigraphie nach Radiojodtherapie [Salivary gland scintigraphy after radio-iodine therapy. Functional scintigraphy of the salivary gland after high dose radio-iodine therapy (author’s transl)]. Rofo 1976;125:546-551.
11
Alexander C, Bader JB, Schaefer A, Finke C, Kirsch CM. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med 1998;39:1551-1554.
12
Van Nostrand D, Bandaru V, Chennupati S, et al. Radiopharmacokinetics of radioiodine in the parotid glands after the administration of lemon juice. Thyroid 2010;20:1113-1119.
13
De Luca R, Vicidomini A, Trodella M, Tartaro G, Colella G. Sialoendoscopy: a viable treatment for I(131) induced sialoadenitis. Br J Oral Maxillofac Surg 2014;52:641-646.
14
Meng Q, Fang W, Long X, Deng M, Li J, Ke J. Sialoendoscopy combined with an internal stent and postoperative massage as a comprehensive treatment of delayed I131-induced parotitis. Br J Oral Maxillofac Surg 2017;55:674-678.
15
Hänscheid H, Lassmann M, Luster M, et al. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 2006;47:648-654.
16
Rosário PW, Borges MA, Purisch S. Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotoxicity. J Nucl Med 2008;49:1776-1782.
17
Grewal RK, Larson SM, Pentlow CE, et al. Salivary gland side effects commonly develop several weeks after initial radioactive iodine ablation. J Nucl Med 2009;50:1605-1610.
18
Newkirk KA, Ringel MD, Wartofsky L, Burman KD. The role of radioactive iodine in salivary gland dysfunction. Ear Nose Throat J 2000;79:460-468.
19
Brown AP, Greening WP, McCready VR, Shaw HJ, Harmer CL. Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience. Br J Radiol 1984;57:323-327.
20
Sialadenitis following iodine-131 therapy for thyroid carcinoma. J Nucl Med 1985;26:816-817.
21
Almeida JP, Sanabria AE, Lima EN, Kowalski LP. Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer. Head Neck 2011;33:686-690.
22
Silberstein EB. Reducing the incidence of 131I-induced sialadenitis: the role of pilocarpine. J Nucl Med 2008;49:546-549.
23
Ma C, Xie J, Jiang Z, Wang G, Zuo S. Does amifostine have radioprotective effects on salivary glands in high-dose radioactive iodine-treated differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2010;37:1778-1785.
24
Bohuslavizki KH, Klutmann S, Brenner W, et al. Radioprotection of salivary glands by amifostine in high-dose radioiodine treatment. Results of a double-blinded, placebo-controlled study in patients with differentiated thyroid cancer. Strahlenther Onkol 1999;175:6-12.
25
Walter MA, Turtschi CP, Schindler C, Minnig P, Müller-Brand J, Müller B. The dental safety profile of high-dose radioiodine therapy for thyroid cancer: long-term results of a longitudinal cohort study. J Nucl Med 2007;48:1620-1625.
26
Nakada K, Ishibashi T, Takei T, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med 2005;46:261-266.
27
Bushnell DL, Boles MA, Kaufman GE, Wadas MA, Barnes WE. Complications, sequela and dosimetry of iodine-131 therapy for thyroid carcinoma. J Nucl Med 1992;33:2214-2221.
28
Silberstein EB, Alavi A, Balon HR, et al. The SNMMI practice guideline for therapy of thyroid disease with 131I 3.0. J Nucl Med 2012;53:1633-1651.
29
Levenson D, Gulec S, Sonenberg M, Lai E, Goldsmith SJ, Larson SM. Peripheral facial nerve palsy after high-dose radioiodine therapy in patients with papillary thyroid carcinoma. Ann Intern Med 1994;120:576-578.
30
Lee TC, Harbert JC, Dejter SW, Mariner DR, VanDam J. Vocal cord paralysis following I-131 ablation of a postthyroidectomy remnant. J Nucl Med 1985;26:49-50.
31
Cambil T, Gil E, Ponce C, Ruiz JV, Castro J. Paresia bilateral de cuerdas vocales tras tratamiento con radioiodo [Bilateral vocal cords paresis following iodine therapy]. Rev Esp Med Nucl 2003;22:97-99.
32
Lee TH, Yaqub A, Norweck J, Ahmed M. A case of esophageal stricture after iodine 131 ablation. Endocr Pract 2012;18:61-64.
33
Fard-Esfahani A, Mirshekarpour H, Fallahi B, et al. The effect of high-dose radioiodine treatment on lacrimal gland function in patients with differentiated thyroid carcinoma. Clin Nucl Med 2007;32:696-699.
34
Hyer SL, Newbold K, Harmer CL. Early and late toxicity of radioiodine therapy: detection and management. Endocr Pract 2010;16:1064-1070.
35
Sweeney DC, Johnston GS. Radioiodine therapy for thyroid cancer. Endocrinol Metab Clin North Am 1995;24:803-839.
36
Winslow CP, Meyers AD. Hypocalcemia as a complication of radioiodine therapy. Am J Otolaryngol 1998;19:401-403.
37
Glazebrook GA. Effect of decicurie doses of radioactive iodine 131 on parathyroid function. Am J Surg 1987;154:368-373.
38
Mazzaferri EL, Massoll N. Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin. Endocr Relat Cancer 2002;9:227-247.
39
Luster M, Clarke SE, Dietlein M, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2008;35:1941-1959.
40
Vini L, Hyer S, Al-Saadi A, Pratt B, Harmer C. Prognosis for fertility and ovarian function after treatment with radioiodine for thyroid cancer. Postgrad Med J 2002;78:92-93.
41
Hyer S, Pratt B, Newbold K, Hamer C. Outcome of Pregnancy After Exposure to Radioiodine In Utero. Endocr Pract 2011 Jan 17:1-10.
42
Raymond JP, Izembart M, Marliac V, et al. Temporary ovarian failure in thyroid cancer patients after thyroid remnant ablation with radioactive iodine. J Clin Endocrinol Metab 1989;69:186-190.
43
Ceccarelli C, Bencivelli W, Morciano D, Pinchera A, Pacini F. 131I therapy for differentiated thyroid cancer leads to an earlier onset of menopause: results of a retrospective study. J Clin Endocrinol Metab 2001;86:3512-3515.
44
Manuel García-Quirós Muñoz J, Martín Hernández T, Torres Cuadro A, Cambil Molina T, Castro Montaño J, Sendón Pérez A. Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides [Age of menopause in patients with differentiated thyroid cancer treated with radioiodine]. Endocrinol Nutr 2010;57:105-109.
45
Dottorini ME, Lomuscio G, Mazzucchelli L, Vignati A, Colombo L. Assessment of female fertility and carcinogenesis after iodine-131 therapy for differentiated thyroid carcinoma. J Nucl Med 1995;36:21-27.
46
Kogai T, Taki K, Brent GA. Enhancement of sodium/iodide symporter expression in thyroid and breast cancer. Endocr Relat Cancer 2006;13:797-826.
47
Hyer S, Vini L, O’Connell M, Pratt B, Harmer C. Testicular dose and fertility in men following I(131) therapy for thyroid cancer. Clin Endocrinol (Oxf) 2002;56:755-758.
48
Pacini F, Gasperi M, Fugazzola L, et al. Testicular function in patients with differentiated thyroid carcinoma treated with radioiodine. J Nucl Med 1994;35:1418-1422.
49
Balan KK, Raouf AH, Critchley M. Outcome of 249 patients attending a nuclear medicine department with well differentiated thyroid cancer; a 23 year review. Br J Radiol 1994;67:283-291.
50
DOBYNS BM, MALOOF F. The study and treatment of 119 cases of carcinoma of the thyroid with radioactive iodine. J Clin Endocrinol Metab 1951;11:1323-1360.
51
Murakami H, Kawahara N, Yahata T, Yokoyama K, Komai K, Tomita K. Radiation myelopathy after radioactive iodine therapy for spine metastasis. Br J Radiol 2006;79:45-49.
52
BENUA RS, CICALE NR, SONENBERG M, RAWSON RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. Am J Roentgenol Radium Ther Nucl Med 1962;87:171-182.
53
Benua RS. A method and rationale for treating metastatic thyroid carcinoma with the largest safe dose of I-131. Frontiers in thyroidology 1986:1317-1321.
54
Dorn R, Kopp J, Vogt H, Heidenreich P, Carroll RG, Gulec SA. Dosimetry-guided radioactive iodine treatment in patients with metastatic differentiated thyroid cancer: largest safe dose using a risk-adapted approach. J Nucl Med 2003;44:451-456.
55
Drouet M, Hérodin F. Radiation victim management and the haematologist in the future: time to revisit therapeutic guidelines? Int J Radiat Biol 2010;86:636-648.
56
Edmonds CJ, Smith T. The long-term hazards of the treatment of thyroid cancer with radioiodine. Br J Radiol 1986;59:45-51.
57
Glanzmann C. Subsequent malignancies in patients treated with 131-iodine for thyroid cancer. Strahlenther Onkol 1992;168:337-343.
58
Hall P, Boice JD Jr, Berg G, et al. Leukaemia incidence after iodine-131 exposure. Lancet 1992;340:1-4.
59
Sawka AM, Thabane L, Parlea L, et al. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 2009;19:451-457.
60
Rubino C, de Vathaire F, Dottorini ME, et al. Second primary malignancies in thyroid cancer patients. Br J Cancer 2003;89:1638-1644.
61
Reiners C, Schneider R, Platonova T, et al. Breast Cancer After Treatment of Differentiated Thyroid Cancer With Radioiodine in Young Females: What We Know and How to Investigate Open Questions. Review of the Literature and Results of a Multi-Registry Survey. Front Endocrinol (Lausanne) 2020;11:381.
62
Vassilopoulou-Sellin R, Palmer L, Taylor S, Cooksley CS. Incidence of breast carcinoma in women with thyroid carcinoma. Cancer 1999;85:696-705.
63
Chen AY, Levy L, Goepfert H, Brown BW, Spitz MR, Vassilopoulou-Sellin R. The development of breast carcinoma in women with thyroid carcinoma. Cancer 2001;92:225-231.
64
Sandeep TC, Strachan MW, Reynolds RM, et al. Second primary cancers in thyroid cancer patients: a multinational record linkage study. J Clin Endocrinol Metab 2006;91:1819-1825.
65
Ronga G, Filesi M, Montesano T,et al. Lung metastases from differentiated thyroid carcinoma. A 40 years’ experience. Q J Nucl Med Mol Imaging 2004;48:12-19.
66
Rall JE, Alpers JB, Lewallen CG, Sonenberg M, Berman M, Rawson RW. Radiation pneumonitis and fibrosis: a complication of radioiodine treatment of pulmonary metastases from cancer of the thyroid. J Clin Endocrinol Metab 1957;17:1263-1276.
67
Reiners C, Biko J, Haenscheid H, et al. Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very high-risk radiation-induced differentiated thyroid carcinoma. J Clin Endocrinol Metab 2013;98:3039-3048.
68
Chen L, Shen Y, Luo Q, Yu Y, Lu H, Zhu R. Pulmonary fibrosis following radioiodine therapy of pulmonary metastases from differentiated thyroid carcinoma. Thyroid 2010;20:337-340.
69
Lee J, Sogutlu G, Leard L, et al. Lung transplantation for pulmonary metastases and radiation-induced pulmonary fibrosis after radioactive iodine ablation of extensive lung metastases from papillary thyroid carcinoma. Thyroid 2007;17:367-369.
70
Vasil’ev LIa, Rozdil’skiĭ SI, Tkachenko GI. Radionuklidnye issledovaniia funktsii pecheni i pochek pri rake shchitovidnoĭ zhelezy posle radioĭodoterapii [Radionuclide research on liver and kidney function in thyroid cancer after radioiodine therapy]. Med Radiol (Mosk) 1987;32:38-41.