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. 2021 Dec 7;38(4):306-313.
doi: 10.4274/tjh.galenos.2021.2021.0092. Epub 2021 Mar 22.

Assessment of Long-Term Hematologic Effects in Differentiated Thyroid Cancer Patients Treated with Radioactive Iodine

Bircan Sönmez  1 , Özlen Bektaş  2 , Nergiz Erkut  2 , Mehmet Sönmez  2
Affiliations

Assessment of Long-Term Hematologic Effects in Differentiated Thyroid Cancer Patients Treated with Radioactive Iodine

Bircan Sönmez et al. Turk J Haematol. .

Abstract
in English, Turkish

Objective: Radioactive iodine (RAI) therapy may cause hematologic abnormalities. The aim of this study is to evaluate long-term hematologic effects in differentiated thyroid cancer (DTC) patients after RAI therapy.

Materials and methods: A total of 1389 patients with DTC who were treated with RAI were retrospectively evaluated. Complete blood cell counts before RAI therapy and at last follow-up and hematologic malignancy development were obtained from the electronic records.

Results: In the long-term analysis, thrombocytopenia and lymphopenia were observed significantly in patients over 60 years of age. Thrombocytopenia was observed more frequently in men. Leukopenia, thrombocytopenia, and lymphopenia were observed significantly with doses of >175 mCi. Thrombocytopenia and lymphopenia were observed significantly with multiple dose administration. Higher frequencies of anemia, thrombocytopenia, leukopenia, neutropenia, and lymphopenia were found in patients with advanced-stage disease. However, patients with advanced-stage disease had higher doses and more multiple doses than patients with early-stage disease. The rate of hematologic malignancy was found to be higher than in the general population.

Conclusion: We suggest that cytopenia be surveyed more carefully in patients older than 60 years of age. The most important risk factor for lower platelets after RAI therapy is male gender. Clinically, the most important predictor for cytopenia is advanced disease stage, which is related to the combined effects of applied high dose activity, multiple dose applications, and high tumor burden.

Amaç: Radyoaktif iyot (RAİ) tedavisi hematolojik anormalliklere yol açabilir. Bu çalışmada, diferansiye tiroid kanserli (DTC) hastalarda RAİ tedavisi sonrası uzun dönemli hematolojik etkilerin değerlendirilmesi amaçlanmıştır.

Gereç ve yöntemler: Bin üç yüz seksen dokuz RAİ ile tedavi edilmiş DTC’li hasta retrospektif olarak değerlendirildi. Tedavi öncesi, son takip ve hematolojik malignite geliştikten sonra ölçülen tam kan sayımları elektronik kayıtlardan elde edildi.

Bulgular: Uzun dönemli analizde trombositopeni ve lenfopeni özellikle 60 yaş üstü bireylerde gözlendi. Trombositopeni erkek hastalarda daha sıktı. Lökopeni, trombositopeni ve lenfopeni >175 mCi dozlarda anlamlı oranda artmıştı. Trombositopeni ve lenfopeni çoklu doz uygulaması olanlarda anlamlı oranda izlendi. Anemi, trombositopeni, lökopeni, nötropeni ve lenfopeni, ileri evre hastalıklı hastalarda daha sıktı. Ancak ileri evre hastalığa sahip hastalar, erken evrelilere göre hem daha yüksek doz hem de çoklu doz tedavi almışlardı. Hematolojik malignite oranı genel popülasyondan daha yüksek oranda idi.

Sonuç: Özellikle 60 yaş üstü hastalar sitopeniler açısından daha yakın izlenmelidir. RAİ tedavi sonrası en önemli risk faktörü erkek cinsiyettir. Klinik olarak sitopeniler için en önemli belirleyici ileri evre hastalıktır, ki bu da, daha yüksek doz ve çoklu doz tedavi uygulanmış olmasının ve daha fazla tümör yükünün kombine etkisi ile ilişkilidir.

Keywords: Radioactive iodine; Thyroid cancer; Cytopenia; Hematologicmalignancy; Long-term hematologic effects; Thrombocytopenia; Neutropenia.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

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