Differentiated thyroid cancer and hemodialysis: Long-term outcomes and safety after radioiodine use.
E. Navarro Gonzalez, A. Martinez Ortega, R. Guerrero Vazquez, M. Martinez Brocca & J. Cuenca Cuenca
Introduction: The use of radioiodine is a common treatment for differentiated thyroid cancer. However, special care should be exercised in treating patients who are on hemodialysis, due to the renal elimination of the radionuclide, which implies several technical difficulties and safety concerns. We have previously described the procedure and the short-term outcome and safety in three patients (Jimenez et al, Thyroid 2001; 11(11):10311034). Our results showed that the radioactive iodine therapy was a safe procedure in these patients. Nevertheless, that report was limited to the short-term outcome.
Objective: To determine the long-term safety and outcome in patients on hemodialysis treated with radioiodine
Methods: We conducted a retrospective descriptive study, searching our clinical record database from 2000 to 2010. Inclusion criteria: Differentiated thyroid cancer and radioiodine treatment on hemodialysis. Exclusion criteria: anaplasic thyroid cancer, medullary thyroid cancer, multiple endocrine neoplasia, peritoneal dialysis. Final sample n=9.
Results: All time periods are expressed as median values. Baseline characteristics: n=5 males, age 48 years; n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 nodal invasion; n=1 metastatic disease. After 7.5 years since radioiodine treatment on hemodialysis, n=7 patients were deemed free of thyroid disease, while only one persisted with non-localized disease. 3.25 years after radioiodine treatment, n=4 patients underwent renal transplantation without complications related to the radioisotope use. The other four patients were not eligible for transplantation due to causes not related to their thyroid disease or the I131 treatment, and no changes in the evolution of their renal disease were recorded. One patient died from cardiac arrest, free of thyroid disease.
Conclusions: The radioiodine treatment in patients on hemodialysis with differentiated thyroid cancer is a safe and effective procedure at medium-long term, and allows renal transplantation without developing a higher risk of complications compared to patients which are not on hemodialysis.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector