Adverse Reactions to Radioiodine 131I Therapy of Goiter in West African Tertiary Hospital

Abstract

Objective: Radioactive iodine therapy (RAIT) is established as an efficient means of treating toxic goiter (TG) globally. The field of nuclear medicine (NM) still appears novel to many Nigerian clinicians and patients. A culturally embedded dread of radiation may raise ethical and moral concerns about potential adverse effects in the wake of RAIT in our setting. An adverse drug reaction may be described as “a response to a drug which is noxious and unintended, and which occurs at doses normally used in man”. This study therefore, seeks to review adverse reactions (ARs) experienced following RAIT. We would also like to improve patient and physician education about the safety profile of RAIT.Methods:This is a retrospective analysis of all patients who had received RAIT for thyroid disease from August 2006 to June 2015.Results: Forty typical ARs were experienced following 36 therapy sessions (18.65%) with RAIT in 35 patients (21.47%) aged 17-78 years, of which three had multiple sessions for well-differentiated thyroid carcinoma (WDTC).Conclusion: RAIT remains a safe option for the treatment of benign and TG. The experienced ARs are mainly mild to moderate in severity and mostly short-lived. As larger doses of radioactive iodine for WDTC and TG were more commonly associated with ARs, our study suggests that these patients merit stronger prophylactic measures as well as closer monitoring for earlier detection and management of these reactions.

Changes in the size of the thyroid in patients with benign non-toxic multinodular goiter after radioactive iodine therapy

“…Nevertheless, it is necessary to know who really requires surgery for it. Aside from surgery, other medical treatments include iodine supplements and treatment with levothyroxine as well as radioactive iodine (RAI) (5). It must be mentioned that treatments such as the injection of necrosis-inducing agents, including ethanol, into nodules have also been administered in some trials.…”

“…Hyperthyroidism could be seen even in some patients after surgery because part of the thyroid tissue is left in place. Hence, in all of these cases, it seems appropriate to apply a pharmacological method (3, 5, 6). RAI therapy is widely used for treating toxic MNG now.…”

Underutilisation of nuclear medicine scans at a regional hospital in Nigeria: need for implementation research

“…Its low cost, ready availability, rapid imaging and lower absorbed dose are major advantages. For patients undergoing radioactive iodine therapy for benign and overactive goitres, it is routinely used to guide empirical dosing [6,41]. However, personalised radioiodine therapy is best achieved by a radioiodine uptake test [39].…”

“…The volume of scans averaging 486 scans per annum is consistent with the other studies reporting similar low throughput of nuclear medicine departments in Sub-Saharan Africa [ 2 , 4 ]. Besides the specific barriers of NM in Nigeria [ 4 , 6 – 9 ], general challenges that affect oncology and healthcare delivery significantly impact on NM scans. Since the majority of the referrals come from oncologists, radiotherapy equipment downtime and industrial strike actions by health professionals trade unions impact on NM services [ 18 ].…”

“…However, the growth of NM in Sub-Saharan Africa continues to face many challenges. The known barriers include ageing equipment [ 4 ], culturally embedded dread of radiation [ 6 ], logistic challenges with radionuclide delivery [ 3 , 7 , 8 ], lack of health insurance [ 9 ], as well as other systemic barriers that limit health systems in developing countries [ 2 , 10 ].…”