Iodine-131 Therapy and Lacrimal Drainage System Toxicity: Nasal Localization Studies Using Whole Body Nuclear Scintigraphy and SPECT-CT

Ali, Mohammad Javed; Vyakaranam, Achyut Ram; Rao, Jyotsna; Prasad, Giri; Reddy, Palkonda Vijay Anand

doi:10.1097/iop.0000000000000603

Cited by 23 publications

(13 citation statements)

References 20 publications

(35 reference statements)

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“…Besides thyroid tissue itself, sweat and salivary glands and the nasal cavity also have the ability to uptake and store iodine through their sodium iodide transporters. Body uids such as gastric juice, cerebrospinal uid, breast milk and fetal blood can also incorporate 131 I [14] leading to an impact of 131 I therapy for DTC on gonadal function and reproductive health. As a result, the effects of 131 I therapy have attracted a great deal of attention [5] .…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics of nasolacrimal duct obstruction after Iodine Therapy of DTC patients

Zhang

2022

Preprint

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Background: The aim was to analyze clinical characteristics of differentiated thyroid carcinoma (DTC) patients with nasolacrimal duct obstruction after 131I therapy and provide guidance for clinical decision-making. Methods: Thirty one DTC patients with nasolacrimal duct obstruction were retrospectively enrolled from the Nuclear Medicine Department of Shanxi Bethune Hospital during follow-up of 131I therapy between June 2018 and March 2021.Sixty one thyroid cancer patients without nasolacrimal duct obstruction after 131I therapy were also enrolled to act as a control group. Clinical characteristics, including sex, age, dose, positive anti-thyroglobulin antibodies (TGAb), metastasis and nasal uptake, were analyzed by χ2 test and logistic multifactor regression. Results: Statistically significant differences were found in patients’ nasal uptake after 131I therapy according to gender (11.8% : 38.7%), age (5.6% : 51.1%), dose (3.4% : 47.6%), stage (18.5% : 70.4%) and iodine uptake (83.3% : 30.2%). There was no significant difference in the proportion of TGAb positive and negative patients according to 131I therapy (χ2=0.27, P=0.782). Multivariate logistic regression analysis showed that gender (2.59), age (1.45), dose (2.36), whether there was iodine uptake of metastatic foci (1.93) and whether there was nasal uptake of iodine (1.70) were all statistically significant influential factors of lacrimal discharge symptoms after iodine therapy. Conclusion: Patients who were over 50, women, had metastatic iodine uptake, received a dose > 5.55GBq and had nasal intake of 131I were more likely to have nasolacrimal duct obstruction. When determining therapeutic doses of 131I, doctors should weigh multiple factors and suggest that high risk populations be referred to the appropriate ophthalmic surgery for timely diagnosis and therapy.

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Section: Discussionmentioning

confidence: 99%

“…Sixteen cases had unilateral or bilateral stenosis with lacrimal drainage system obstruction con rmed by ophthalmologists. Ali MJ et al [14] found that no patient receiving 3.7 GBq had symptoms but 4% (2 / 50) of patients receiving more than 5.55 GBq did. High dose 131 I is therefore associated with nasolacrimal duct obstruction.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of nasolacrimal duct obstruction after Iodine Therapy of DTC patients

Zhang

2022

Preprint

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“…RAI is excreted in tears and actively accumulated in LDS and subsequently lacrimal gland impairment [35] as well as epiphora can develop since the low, but concentrated level of RAI induces inflammation that stimulates stenosis or obstruction [36]. Investigating RAI administration in a high number of patients, a cutoff level of 150 mCi was determined since toxicity and consecutive inflammation that leads to obstruction of LDS occurred in patients who received RAI doses above this level [37].…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

Barna¹,

Garai²,

Kukuts³

et al. 2019

Ann Nucl Med

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PurposeEpiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.MethodsDynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.ResultsFifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.ConclusionsAlthough DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction.

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“…и M. Ali и cоавт. [10][11][12] с помощью однофотонной эмиссионной компьютерной томографии (ОФЭКТ) выявили накопление радиоактивного йода в тканях носослезного протока у пациентов после терапии радиоактивным йодом. Эти данные позволяют считать поражение слезоотводящих путей специфическим осложнением терапии радиоактивным йодом.…”

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“…M. Ali и соавт. [12] показали, что нарушения слезоотведения зависят от дозы радиоактивного йода. С помощью ОФЭКТ накопление радиоактивного йода в области носовой полости и носослезного протока было выявлено у пациентов, получавших терапию радиоактивным йодом в дозе 100 мКи (50 наблюдений) и более 150 мКи (50 наблюдений).…”

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Secondary acquired nasolacrimal duct obstruction after radioiodine therapy

Yartsev

Дмитриевич²,

Atkova

et al. 2019

Probl Endokrinol (Mosk)

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Secondary acquired nasolacrimal duct obstruction after radioiodine therapy is a comparatively rare complication but it requires treatment at an early stage. The symptoms of secondary acquired nasolacrimal duct obstruction are tearing, eye redness, discharge at ocular surface, a mass growing at lacrimal sac site. The considered complication occurs after radioiodine therapy in dose of 150 mCi, the rate of occurrence is dose-dependent. There are no clinical guidelines for preventing this complication but there are reports of nasolacrimal duct preventive intubation and those about developing new drug agents that block an action of the protein that uptakes iodine in the nasolacrimal duct mucosa. For diagnosing, special diagnostic procedures and an ophthalmologist consultation are required. For the correction of this complication, conservative treatment (with low efficacy) and special surgical treatment are used, including nasolacrimal duct recanalization with different techniques and anastomosis between nasolacrimal duct and nasal cavity formation. In cases of early patient encounter, it is possible to use more functional and less invasive surgical techniques, in cases of late encounter, more invasive surgical techniques are used.

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Iodine-131 Therapy and Lacrimal Drainage System Toxicity: Nasal Localization Studies Using Whole Body Nuclear Scintigraphy and SPECT-CT

Abstract: Intranasal localization of radioactive I-131 was significant in patients receiving a dose of ≥150 mCi. Intranasal localization may partly explain toxicity to nasolacrimal duct and may be a risk factor for subsequent development of nasolacrimal duct obstructions.

Cited by 23 publications

References 20 publications

Clinical characteristics of nasolacrimal duct obstruction after Iodine Therapy of DTC patients

Clinical characteristics of nasolacrimal duct obstruction after Iodine Therapy of DTC patients

Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

Secondary acquired nasolacrimal duct obstruction after radioiodine therapy

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