Iodine 131 treatment for differentiated thyroid carcinoma in patients with end stage renal failure: dosimetric, radiation safety, and practical considerations

Abstract

I retention measurements performed post dialysis; in two of them some additional measurements such as iodine clearances were also performed. rEsULts: None of the patients experienced any short-term side effects, while they all had undetectable thyroglobulin levels on the first post therapy evaluation off thyroxine. 131I elimination in the first haemodialysis was about 60%. staff incidental exposure and 131 I contamination were insignificant. cONcLUsIONs: On the basis of our experience, an empiric activity of 40-50% of that used for normal individuals appears to be effective as well as safe. these encouraging findings are discussed in relation with other reports in the literature.

Thyroid dysfunction and kidney disease

“…Treatment with ablative dose of 131 I has been successfully used in the treatment of differentiated thyroid carcinoma in patients on HD (108,(130)(131)(132)(133)(134)(135)(136). HD removes more 131 I from blood than from thyroid and helps to reduce radiation (132).…”

“…When hypothyroidism develops, left ventricular function can be compromised but this is not specific to PD patients. Because 131 I is eliminated primarily by the kidney some authors have recommended a reduction of w fivefold in the dose of 131 I used in the treatment of differentiated thyroid carcinoma in PD patients to avoid excessive radiation, primarily at bone marrow level (140,141).…”

Radiation Safety Procedures For Non-Radiation Workers in Case of Application Radionuclide Therapy in the Dialysis Patients

“…Özellikle anürik diyaliz hastalarında azalan I-131 klirensi nedeniyle, artan radyasyon maruziyetini azaltmak için, diyaliz hastası olmayan hastalara verilen dozun %25-50'sinin verilmesinin uygun olabileceğine dair yayınlar mevcuttur (7,8,9,10,11,12,13). Bu nedenle, en önemli önlemlerden biri tedavi verilecek günün sabahı hastanın diyalize alınması, tedavinin diyaliz seansı arkasından uygulanması ve bir sonraki diyaliz seansının zamanında yapılmasıdır (13). Ancak, bu seans çevrenin korunması amacıyla hasta yoğunluğunun az olduğu zamana denk getirilmelidir.…”

“…Cihazın temizliğinden sonra, cihaz diğer hastalara kullanılabilir. Ek bekleme süresine gerek yoktur (13) .…”

Is it necessary to reduce the radioiodine dose in patients with thyroid cancer and renal failure?

“…Tissue mass estimated by ultrasonography, scintigraphy or radioiodine uptake in the cervical area may incur inaccuracy and innate difficulties in determining volumetric and mass dimensions in structures with a highly variable morphology. This occurs through using imprecise measurement methodologies as well as the extreme variability in radioiodine uptake brought about by the functional behavior of the remaining cells in the thyroid bed after surgery (12)(13)(14)(15).…”