A systematic review of the gonadal effects of therapeutic radioactive iodine in male thyroid cancer survivors

Clinical Endocrinology - Tập 68 Số 4 - Trang 610-617 - 2008
Anna M. Sawka1,2, Jane Lea3, Bandar M. Alshehri4, Sharon E. Straus5,6, Richard Tsang7,8, James D. Brierley7,8, Lehana Thabane9,10, Lorne Rotstein11,12, Amiram Gafni13,10, Shereen Ezzat14,1,15,16, David P. Goldstein17
1Division of Endocrinology, Department of Medicine,
2Division of Endocrinology, Department of Medicine, University Health Network Toronto, Ontario, Canada,
3Department of Otolaryngology, Head and Neck Surgery
4Division of Endocrinology, Department of Medicine, and
5Department of Knowledge Translation, University of Toronto, Ontario, Canada.
6Division of Geriatrics, Department of Medicine, University of Calgary, Calgary, Alberta, Canada,
7Department of Radiation Oncology, University Health Network Toronto, Ontario, Canada,
8Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
9Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Ontario, Canada
10Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
11Department of Surgery, University Health Network, Toronto, Ontario, Canada
12Department of Surgery, University of Toronto, Toronto, Ontario, Canada
13Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario,
14Division of Endocrinology and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
15The Freeman Centre for Endocrine Oncology, Toronto, Ontario, Canada,
16The Ontario Cancer Institute, Toronto, Ontario, Canada and
17Department of Otolaryngology Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.

Tóm tắt

SummaryBackground  For patients with well‐differentiated thyroid carcinoma (WDTC), the gonadal effects of radioactive iodine (RAI) therapy is an important consideration.Objective and methods  We systematically reviewed the controlled studies examining the gonadal effects of RAI therapy in male WDTC survivors. We searched in nine electronic databases. All abstracts and papers were independently reviewed by two reviewers.Results  After reviewing 334 abstracts and 59 full‐text papers, seven papers were included. In longitudinal studies examining the effect of single primary RAI dose activities of ≤ 150 mCi, serum FSH and LH rose between months 2 and 6, with normalization by 18 months; serum testosterone did not significantly decrease. In one study, 18 months after RAI, the rates of elevated serum FSH were: 27% for 351–594 mCi and 81% for > 594 mCi. Cumulative RAI dose correlated with FSH measurements at long‐term follow‐up. In one study, approximately one in eight men experienced oligospermia 1 year after RAI therapy. Rates of infertility, pregnancy loss and offspring congenital malformation were not elevated, but studies were limited by small size and self‐reported outcomes.Conclusions  Abnormalities in testicular function are common within several months of a single therapeutic dose of RAI for WDTC. Biochemical abnormalities usually resolve within 18 months after administration of a single activity of < 150 mCi of RAI. The risk of persistent gonadal dysfunction is increased after repeated or high cumulative RAI activities. Controlled, prospective studies, with long‐term follow‐up, examining male gonadal and offspring effects of RAI therapy are needed.

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Clinical Endocrinology

Tập 68 Số 4

610-617

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