Effects of Radioactive Iodine Therapy on Ovarian Reserve: A Prospective Pilot Study

Evranos, Berna; Fakı, Sevgül; Polat, Şefika Burçak; Beştepe, Nagihan; Ersoy, Reyhan; Çakır, Bekir

doi:10.1089/thy.2018.0129

Cited by 35 publications

(41 citation statements)

References 30 publications

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“…In contrast, five patients who were treated for Graves' disease with a mean activity of 13 mCi did not have a decrease in AMH (40). The second study, from Turkey, evaluated 33 women, at a mean age of 31 years, after receiving RAI after thyroid hormone withdrawal at a mean activity of 111 mCi (41). This study showed similar findings, with significant drop of AMH at 3 months, with only slight recovery by 12 months.…”

Section: Radioactive Iodinementioning

confidence: 72%

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Thyroid and Fertility: Recent Advances

Dosiou

2020

Thyroid

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Background: Thyroid disease is prevalent in women of reproductive age, while infertility is common in women with thyroid dysfunction. In this study, we review the recent advances in the field of thyroid and fertility since the publication of the 2017 American Thyroid Association pregnancy guidelines. Summary: Recent studies have confirmed associations of thyrotropin (TSH) elevation and/or thyroid autoimmunity with infertility and low ovarian reserve in subsets of women, and have led to a better understanding of the pathogenesis linking thyroid autoimmunity with infertility. Even though the benefit of treating patients with TSH >4 mIU/L has been confirmed in a large retrospective cohort study, two large randomized controlled trials have failed to show benefit of thyroid hormone on obstetrical outcomes in euthyroid women with thyroid autoimmunity. New data have emerged regarding the potential gonadal toxicity of radioactive iodine (RAI), based on its impact on ovarian reserve and sperm chromosomal abnormalities. Conclusions: There is continued evidence supporting an important role of thyroid hormone in regulation of reproductive tissues at many levels. Recent randomized trials have failed to identify a benefit of thyroid hormone in euthyroid women with thyroid autoimmunity. Further research in the field is needed to more completely delineate the relevant pathways and identify women who may benefit from levothyroxine treatment. The impact of RAI on fertility also merits further investigation.

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Section: Radioactive Iodinementioning

confidence: 72%

“…This study showed similar findings, with significant drop of AMH at 3 months, with only slight recovery by 12 months. Women over the age of 30 years had higher decreases in AMH than younger women (41).…”

Section: Radioactive Iodinementioning

confidence: 84%

Thyroid and Fertility: Recent Advances

Dosiou

2020

Thyroid

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“…In both studies, the interval between thyroidectomy and RAI administration and AMH sample collection was of several months: more than 36 months in the Acibucu et al study [14] and 5 years on average in our study [15]. Recently, Yaish et al [16] and Evranos et al [17] designed similar studies in which AMH was evaluated before and 3-12 months after RAI administration in DTC females. These studies showed a significant decrease in AMH levels, with lower levels 3 months after RAI, and an increasing trend in the following months, though pre-RAI levels were not reached by the 12-month evaluation.…”

Section: Introductionmentioning

confidence: 60%

Cross-sectional and prospective study on anti-Müllerian hormone changes in a cohort of pre-menopausal women with a history of differentiated thyroid cancer

et al. 2020

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Background: Anti-Müllerian hormone (AMH) decreases acutely after post-surgical radioactive iodine (RAI) ablation in females with differentiated thyroid cancer (DTC). Aim: We performed a cross-sectional and prospective study on AMH levels in pre-menopausal females with a history of DTC. Methods: Fifty-nine females after surgery and RAI (group 1) and 30 females after surgery alone (group 2) were studied. The control group consisted of 141 healthy women (group 3). The prospective study was performed in 43 and 14 females from groups 1 and 2, respectively. Results: On first evaluation, AMH levels were similar in groups 1 and 2, but lower than in group 3. In all groups, AMH was negatively related with chronological age and FSH levels. When subjects were stratified according to age, AMH levels were not different between groups. When AMH was evaluated up to 2 years after the baseline evaluation, no changes emerged in either group of women with DTC. In the prospective study, the incidence of abnormal menstrual cycles and the onset of menopause were observed in similar percentages of women with a history of RAI-treated DTC and of those treated with surgery alone. Conclusions: AMH can be considered a reliable index of ovarian reserve in women with DTC. Chronological age is the main factor influencing AMH levels in both DTC patients and controls. After age-related stratification, AMH levels are similar in women with DTC treated with RAI and those treated with surgery alone.

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“…Radiation therapy was also recognized as highly ovario-toxic even at low doses, associated to 149 extremely low or undetectable AMH dosages in the post-treatment patients [55]. In 2018, a prospective pilot study showed decreased ovarian reserve of thyroid carcinoma patients after radioiodine therapy, the median AMH levels being 3.25 (0.32-17.42), 1 (0.01-3.93), 1.13 (0.08-6.12), and 1.37 (0.09-6.1) ng/ml before and in the 3rd, 6th, and 12th month after therapy [56]. A prospective study showed that AMH levels of 42 pediatric females with cancer who had underwent fertility preservation procedures dropped by approximately 40-50%, and their AMH levels after anti-cancer and ovarian folliculus preservation therapy increased until approximatly10 years later and then decreased [57].…”

Section: Discussionmentioning

confidence: 97%

The time-interval of ovarian reserve recovery after laparoscopic unilateral ovarian nonendometriotic cystectomy: a prospective cohort study

Li¹,

Yan²,

Wang³

et al. 2019

Preprint

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Background: Ovarian benign cyst, frequently seen in women of reproductive age, is one of the most important causes of damaging effect of ovarian reserve. Laparoscopic ovarian cystectomy is established as the gold standard surgical approach to the ovarian benign cyst. Studies have shown that potential fertility can be directly impaired by laparoscopic ovarian cystectomy and diminished ovarian reserve. There is little data about the time-interval of ovarian reserve recovery after the laparoscopic unilateral ovarian cystectomy. The objective of this study was to investigate the time-interval of ovarian reserve recovery after laparoscopic unilateral ovarian nonendometriotic cystectomy.Method: In the first part of the study, a total number of 67 patients with unilateral ovarian nonendometriotic cyst who underwent laparoscopic unilateral ovarian cystectomy were recruited as a postoperative observation group (POG). A total number of 69 same-aged healthy women without ovarian cyst who did not undergo surgery were recruited as a referent group (RFG).The serum anti-Müllerian hormone (AMH) levels were measured using a commercially available enzyme-linked immunosorbent assay kit; the Follicle-stimulating hormone (FSH)and E2 levels, measured using a chemiluminescent reagent kit. The ovarian arterial resistance index (OARI) and AFC were measured by transvaginal ultrasonography on the 3rd-5th day of the same menstrual cycle. In the second part of the study, a prospective postoperative 6-month follow-up of cases was performed. Results: When compared with RFG, the AFC of POG’s cyst side showed no difference in the 1st, 3rd, 6th postoperative month (F = 0.03, 0.02, 0.55; P = 0.873, 0.878, 0.460). The OARI of POG’s cyst side presented no difference in the 1st, 3rd, 6th postoperative month ( F = 0.73, 3.57, 1.75; P=0.395, 0.061, 0.188). In the first month, the postoperative AMH levels declined significantly, 1.88 ng/ml (IQR: 1.61-2.16 ng/ml) in POG and 2.57 ng/ml (IQR: 2.32-2.83 ng/ml) in RFG (F = 13.43; P = 0.000). At the time interval, the rate of decline was significantly lower postoperatively than preoperatively in POG (32.75 %),and was also the case in the comparison of POG with RFG (26.67 %). Conclusions: After the laparoscopic unilateral ovarian cystectomy, the optimal time-interval can be the 6th month for ovarian reserve recovery. Semiannually, AMH levels were to be detected to find those whose window time to conceive was likely to be shorter than others of the same age.

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Effects of Radioactive Iodine Therapy on Ovarian Reserve: A Prospective Pilot Study

Abstract: AMH is considered an important marker of ovarian reserve. Ovarian reserve decreased after RAI therapy. More attention may be needed when considering RAI therapy for patients with reduced ovarian reserve.

Cited by 35 publications

References 30 publications

Thyroid and Fertility: Recent Advances

Thyroid and Fertility: Recent Advances

Cross-sectional and prospective study on anti-Müllerian hormone changes in a cohort of pre-menopausal women with a history of differentiated thyroid cancer

The time-interval of ovarian reserve recovery after laparoscopic unilateral ovarian nonendometriotic cystectomy: a prospective cohort study

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