Skip to main content

Advertisement

SpringerLink
Log in

Parathyroid changes after high dose radioactive iodine in patients with thyroid cancer

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

The study aimed to investigate the effect of high dose radioactive iodine (RAI) on parathyroid function in patients with differentiated thyroid cancer.

Methods

Nineteen patients (8 men/11 women, age 46.5 ± 13.2 years) undergoing RAI for thyroid remnant ablation were enrolled in the study. The biochemical parameters related to parathyroid function [serum calcium (Ca), phosphate (P), creatinine (Cr), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), urinary Ca, cAMP concentrations and the maximum tubular capacity for phosphate per unit volume of glomerular filtrate (TmP/GFR)] were evaluated at baseline and at the 1st, 3rd, 6th and 12th months of RAI administration. SPSS 15.0 was used for statistical analysis.

Results

For all patients, thyroid-stimulating hormone levels were >30 U/ml at baseline and <0.1 U/ml at the following visits. Serum iPTH levels were decreased significantly at the 6th month and reached basal levels at the 12th month (baseline vs. 6th p = 0.027, 1st vs. 6th p = 0.011, 3rd vs. 6th p = 0.047, 3rd vs. 12th p = 0.014, 6th vs. 12th p = 0.001). At the 6th month, P and TmP/GFR levels were higher (p = 0.036, 0.017, respectively), and urinary cAMP measurements were lower (p = 0.020) compared to those of the 1st month. No difference was detected concerning the other parameters. Serum Ca levels decreased below 2.1 mmol/l in several patients (n = 5 at 1st month, n = 4 at 3rd month, n = 8 at 6th month and n = 3 at 12th month) without clinical symptoms.

Conclusions

The study indicated a transient decline in PTH levels at the 6th month following RAI therapy. Although this decrease did not cause symptoms in any of the present cases, this pattern might be important especially in individuals with diminished parathyroid background.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803.

    Article  PubMed  CAS  Google Scholar 

  2. Christensson T. Hyperparathyroidism and radiation therapy. Ann Intern Med. 1978;89:216–7.

    PubMed  CAS  Google Scholar 

  3. Russ JE, Scalon EF, Sener SF. Parathyroid adenomas following irradiation. Cancer. 1979;43:1078–83.

    Article  PubMed  CAS  Google Scholar 

  4. Rao SD, Frame B, Miller MJ, Kleerekoper M, Block MA, Parfitt AM. Hyperparathyroidism following head and neck irradiation. Arch Intern Med. 1980;140:205–7.

    Article  PubMed  CAS  Google Scholar 

  5. Stephen AE, Chen KT, Milas MM, Siperstein AE. The coming of age of radiation-induced hyperparathyroidism: evolving patterns of thyroid and parathyroid disease after head and neck radiation. Surgery. 2004;136:1143–53.

    Article  PubMed  Google Scholar 

  6. Eipe J, Johnson SA, Kiamko RT, Bronsky D. Hypoparathyroidism following 131-I therapy for hyperthyroidism. Arch Intern Med. 1968;121:270–2.

    Article  PubMed  CAS  Google Scholar 

  7. Fulop M. Hypoparathyroidism after 131 I therapy. Ann Intern Med. 1971;75:808.

    PubMed  CAS  Google Scholar 

  8. Orme MC, Conolly ME. Hypoparathyroidism after iodine-131 treatment of thyrotoxicosis. Ann Intern Med. 1971;75:136–7.

    PubMed  CAS  Google Scholar 

  9. Better OS, Garty J, Brautbar N, Barzilai D. Diminished functional parathyroid reserve following I-131 treatment for hyperthyroidism. Isr J Med Sci. 1969;5:419–522.

    PubMed  CAS  Google Scholar 

  10. Jialal I, Pillay NL, Asmal AC. Radio-iodine-induced hypoparathyroidism. A case report. S Afr Med J. 1980;58:939–40.

    PubMed  CAS  Google Scholar 

  11. Rosen IB, Palmer JA, Rowen J, Luk SC. Induction of hyperparathyroidism by radioactive iodine. Am J Surg. 1984;148:441–5.

    Article  PubMed  CAS  Google Scholar 

  12. Esselstyn CB Jr, Schumacher OP, Eversman J, Sheeler L, Levy WJ. Hyperparathyroidism after radioactive iodine therapy for Graves disease. Surgery. 1982;92:811–3.

    PubMed  Google Scholar 

  13. Holten I, Christiansen C. Unchanged parathyroid function following irradiation for malignancies of the head and neck. Cancer. 1984;53:874–7.

    Article  PubMed  CAS  Google Scholar 

  14. Talmi YP, Wolf GT, Esclamado R, Carroll WR, Sassler AM. Ionized serum calcium levels following combined treatment for cancer of the head and neck. Laryngoscope. 1993;103:1048–51.

    Article  PubMed  CAS  Google Scholar 

  15. Endres DB, Rude RK. Mineral and bone metabolism. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. Missouri: Elsevier & Saunders; 2006. p. 1891–924.

    Google Scholar 

  16. Walton RJ, Bijvoet OL. Nomogram for derivation of renal threshold phosphate concentration. Lancet. 1975;2:309–10.

    Article  PubMed  CAS  Google Scholar 

  17. Glazebrook GA. Effect of decicurie doses of radioactive iodine 131 on parathyroid function. Am J Surg. 1987;154:368–73.

    Article  PubMed  CAS  Google Scholar 

  18. Mortensen LS, Smidt K, Jørgensen A, Nielsen JT, Laurberg P, Søndergaard L, et al. Long-term parathyroid- and c-cell function after radioiodine for benign thyroid diseases. Basic Clin Pharmacol Toxicol. 2005;97(1):22–8.

    Article  PubMed  CAS  Google Scholar 

  19. Utiger RD. The thyroid: physiology, thyrotoxicosis, hypothyroidism, and the painful thyroid. In: Felig P, Frohman LA, editors. Endocrinology & metabolism. USA: McGraw-Hill; 2001. p. 261–348.

    Google Scholar 

  20. Dohán O, De la Vieja A, Paroder V, Riedel C, Artani M, Reed M, et al. The sodium/iodide symporter (NIS): characterization, regulation, and medical significance. Endocr Rev. 2003;24:48–77.

    Article  PubMed  Google Scholar 

  21. Morgan WF, Sowa MB. Non-targeted bystander effects induced by ionizing radiation. Mutat Res. 2007;616:159–64.

    PubMed  CAS  Google Scholar 

  22. Tzanela M, Thalassinos NC, Nikou A, Georgiadis G, Philokiprou D. Effect of 131I treatment on the calcitonin response to calcium infusion in hyperthyroid patients. Clin Endocrinol (Oxf). 1993;38:25–8.

    Article  CAS  Google Scholar 

  23. Hänscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, et al. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med. 2006;47:648–54.

    PubMed  Google Scholar 

  24. Gómez N, Gómez JM, Orti A, Gavaldà L, Villabona C, Leyes P, et al. Transient hypothyroidism after iodine-131 therapy for Grave’s disease. J Nucl Med. 1995;36(9):1539–42.

    PubMed  Google Scholar 

  25. Biondi B, Filetti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab. 2005;1:32–40.

    Article  PubMed  CAS  Google Scholar 

  26. Potts JT. Parathyroid hormone: past and present. J Endocrinol. 2005;187:311–25.

    Article  PubMed  CAS  Google Scholar 

  27. Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology. 1995;136:3024–30.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet cad., Capa, 34390, Istanbul, Turkey

    Aytekin Guven, Serpil Salman, Harika Boztepe, Sema Yarman, Refik Tanakol, Halil Azizlerli & Faruk Alagol

Authors
  1. Aytekin Guven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serpil Salman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harika Boztepe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sema Yarman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Refik Tanakol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Halil Azizlerli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Faruk Alagol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Faruk Alagol.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guven, A., Salman, S., Boztepe, H. et al. Parathyroid changes after high dose radioactive iodine in patients with thyroid cancer. Ann Nucl Med 23, 437–441 (2009). https://doi.org/10.1007/s12149-009-0270-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-009-0270-4

Keywords

Search

Navigation