Severe Hyponatremia in Association with I131 Therapy in a Patient with Metastatic Thyroid Cancer

Nozu, Tsukasa; Yoshida, Yasuhiko; Ohira, Masumi; Okumura, Toshikatsu

doi:10.2169/internalmedicine.50.5740

Cited by 19 publications

(26 citation statements)

References 25 publications

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“…As can be seen in previous case reports [6]–[10], most of the patients were above 60 years of age and all of the patients showed quite severe hyponatremia with serum sodium levels ranging from 107 mEq/L to 121 mEq/L. In contrast to the earlier case reports [6]–[10], in a recent prospective study of 212 patients with DTC [5], 8.5% of the patients had mild hyponatremia (serum sodium level, 130–136 mEq/L) and 1.9% of the patients had moderate to severe hyponatremia (serum sodium level less than 130 mEq/L), and none of the patients had a serum sodium level less than 120 mEq/L. Hence, the authors asserted that clinically-important hyponatremia was uncommon and sodium concentration might not need to be monitored unless the patients had impaired renal function or they were on diuretics in the setting of acute severe hypothyroidism.…”

Section: Discussionsupporting

confidence: 75%

“…In one case report, a 66 year old female patient visited the emergency room and had serum sodium level of 107 mEq/L after low-iodine diet for thyroid ablation, and the author suggested that prolonged low-iodine diet, low salt intake, and use of thiazide diuretics in elderly patients were risk factors for the development of life-threatening hyponatremia [8]. As can be seen in previous case reports [6]–[10], most of the patients were above 60 years of age and all of the patients showed quite severe hyponatremia with serum sodium levels ranging from 107 mEq/L to 121 mEq/L. In contrast to the earlier case reports [6]–[10], in a recent prospective study of 212 patients with DTC [5], 8.5% of the patients had mild hyponatremia (serum sodium level, 130–136 mEq/L) and 1.9% of the patients had moderate to severe hyponatremia (serum sodium level less than 130 mEq/L), and none of the patients had a serum sodium level less than 120 mEq/L.…”

Section: Discussionmentioning

confidence: 95%

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Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

et al. 2014

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BackgroundDue to the alarming increase in the incidence of thyroid cancer worldwide, more patients are receiving postoperative radioactive iodine (RAI) therapy and these patients are given a low-iodine diet along with levothyroxine withdrawal to induce a hypothyroid state to maximize the uptake of RAI by thyroid tissues. Recently, the reported cases of patients suffering from life-threatening severe hyponatremia following postoperative RAI therapy have increased. This study aimed to systematically assess risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients.MethodsWe reviewed the medical records of all thyroid cancer patients who underwent thyroidectomy and postoperative RAI therapy from July 2009 to February 2012. Demographic and biochemical parameters including serum sodium and thyroid function tests were assessed along with medication history.ResultsA total of 2229 patients (47.0±11.0 years, female 76.3%) were enrolled in the analysis. Three hundred seven patients (13.8%) of all patients developed hyponatremia; 44 patients (2.0%) developed moderate to severe hyponatremia (serum Na+≤130 mEq/L) and another 263 (11.8%) patients showed mild hyponatremia (130 mEq/L

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

et al. 2014

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“…There are ten reported cases in the literature of subjects that have developed hyponatremia while undergoing treatment for differentiated thyroid cancer [16,17,18,19,20]. All ten patients were placed on a low-iodine diet (the duration and severity of the dietary restrictions varied).…”

Section: Thyroid Cancer and Hyponatremiamentioning

confidence: 99%

Hyponatremia and the Thyroid: Causality or Association?

Pantalone¹,

Hatipoğlu²

2014

JCM

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Thyroid disorders, particularly hypothyroidism, have historically been implicated in the development of serum hyponatremia. However, in more recent years, this paradigm has been challenged, and it has been suggested that the link between hypothyroidism and hyponatremia may merely be an association. This review will focus on the thyroid and its link with serum hyponatremia, and review the available literature on the topic.

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“…Patients with metastatic thyroid cancer may exhibit severe symptomatic hyponatremia if thyroxine treatment is stopped before the administration of radioactive iodine (35,36,37). However, low-iodine diet associated with low solute intake, as well as the underlying neoplasia, may contribute to the development of hyponatremia in these cases (21).…”

Section: How Real Is the Association Between Hyponatremia And Hypothymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment

Liamis

Filippatos

Liontos

et al. 2017

European Journal of Endocrinology

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Background: Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L). Summary: The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. Conclusions: Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly.

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Severe Hyponatremia in Association with I131 Therapy in a Patient with Metastatic Thyroid Cancer

Cited by 19 publications

References 25 publications

Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

Hyponatremia and the Thyroid: Causality or Association?

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment

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