Patients were assessed at an average of 8 years after the diagnosis of Graves’ disease. Patients in surgery group were generally younger (average age 35 years, compared to 43 years for the antithyroid drug group and 54 years for the radioactive iodine therapy group). More patients in radioactive iodine therapy group had other medical conditions that may affect quality of life (44%, compared to 29% in the antithyroid drug group and 33% in the surgery group). Overall, patients with treated Graves’ disease had worse thyroid-related quality of life scores than the general population. Among the three treatment groups, patients who received radioactive iodine therapy had worse thyroid-specific quality of life scores than patients treated with antithyroid drugs or surgery, as measured by ThyPRO. The radioactive iodine therapy group had worse scores for goiter symptoms, hyperthyroid symptoms, tiredness, anxiety, depression, emotional susceptibility, impaired social life, impaired daily life, and impaired sex life than the antithyroid drug and surgery groups. In addition, the radioactive iodine therapy group had worse scores in hypothyroid symptoms, eye symptoms, and appearance than the antithyroid drug group. A similar pattern was found in general quality of life measures as assessed with the SF-36 questionnaire, with worse scores in radioactive iodine therapy group compared to the antithyroid drug or surgery groups. WHAT ARE THE IMPLICATIONS OF THIS STUDY? — Sun Y. Lee, MD
What Are Side Effects Associated with Using Iodine?Side effects associated with use of Iodine, include the following:
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. What Other Drugs Interact with Iodine?If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first. Iodine has no known severe, serious, or moderate interactions with other drugs. Mild Interactions of iodine include: This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine. After thyroid cancer surgery, many patients should be in the position of deciding with their doctors whether to pursue treatment with radioactive iodine to help ease long-term follow-up and offer reassurance that the cancer is gone. A new survey by researchers at the University of Michigan Rogel Cancer Center and U-M Institute for Healthcare Policy and Innovation suggests many patients are receiving the treatment when there’s no strong indication of benefit — and a majority may feel like they don’t really have a choice about it. “If these patients are empowered to have more say in whether they receive radioactive iodine, one, it might decrease overtreatment and, two, there might be more long-term patient satisfaction with their outcomes and their choices — especially given the burdens that side effects and treatment costs can have,” says study senior author Megan Haymart, M.D., a clinician and health services researcher at Michigan Medicine. The research team’s findings appear in the Journal of Clinical Oncology. Selective use recommended for most patients Clinical guidelines recommend radioactive iodine for the highest risk patients, and recommend against it for the lowest risk patients. But most patients fall somewhere in the middle, where more cautious, case-by-case decision-making is recommended, Haymart explains. This places the responsibility for whether to pursue the treatment squarely on the shoulders of doctors and their patients. In the study sample of more than 1,300 of these middle-ground patients, the researchers found that 76% received radioactive iodine and more than half felt they weren’t given a choice in the matter. The patients were identified using the National Cancer Institute Surveillance, Epidemiology, and End Result registries in California and Georgia. “In our prior work, we found that there’s wide variation in the use of radioactive iodine,” says Haymart, associate professor of medicine. “And in some instances we found more aggressive use or more intensive use than would be recommended by the guidelines. “So, we wanted to look specifically at the patients’ role in decision making,” she says. “In this group of patients for whom selective use is recommended — where there should be a conversation between the patient and physician — did they feel they had a choice as to whether or not they received radioactive iodine? And, unfortunately, the answer is that many did not.” Patients’ perception of not having a choice was associated both with greater receipt of the treatment, as well as with lower satisfaction with the decision after the fact, even when adjusting for treatment-related side effects, notes study first author Lauren Wallner, Ph.D., M.P.H., assistant professor of medicine at Michigan Medicine. Long-term side effects from radioactive iodine treatment can impact patients’ quality of life, Haymart says. The biggest issue is damage to patients’ salivary glands and tear ducts caused by the radiation. The most commonly reported symptoms include swelling and tenderness of the salivary glands, dry mouth, increased dental cavities and excess tearing due to tear duct obstructions. Patients may also briefly experience side effects leading up to and shortly after treatment. They may be placed on low-iodine diets that require cutting down or avoiding foods like dairy, fish and green vegetables. They also have to stop taking thyroid hormone replacement or receive injections of thyrotropin alfa (Thyrogen) prior to radioactive iodine treatment. During the period when they are off thyroid hormone replacement, patients may experience fatigue, mental slowing and weight gain. However, after radioactive iodine treatment is complete, thyroid hormone replacement is restarted and these symptoms typically resolve. Recommendations for patients and doctors Why are such a large percentage of patients receiving iodine treatment? Several factors may be at play, Haymart says. One is historical precedent. For many years, radioactive iodine was a standard treatment for most thyroid cancer patients — until outcomes data cautioned that a less aggressive approach might be appropriate for those outside of the highest-risk categories. Another might be a form of confirmation bias: If a doctor gives a treatment and their patient does well, it’s easy to believe that the patient did well because of the treatment — even if they might have done equally well without it. Haymart says it’s important for patients to ask their doctors about the potential benefits and risks of radioactive iodine treatment. “They should ask what the side effects of this treatment are likely to be,” she says. “And what the doctor expects to be different in regard to outcome if they receive the treatment or if they decide not to pursue the treatment.” On the physician side, Haymart cautions against a one-size-fits-all approach. “Doctors should take into account the individual patient, their perspectives and their disease severity, and work with the patients to make these decisions,” she says. “Especially in cases such as this where there’s not great data on benefit and there are known risks, the patient needs to be fully aware of both the benefits and the risks, and be empowered to have a say in whether treatment occurs.”
New study findings show an association between the dose of a common treatment for hyperthyroidism and risk of death from solid cancers. Findings from a study of patients who received radioactive iodine (RAI) treatment for hyperthyroidism show an association between the dose of treatment and long-term risk of death from solid cancers, including breast cancer. The study, led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, was published July 1, 2019 in JAMA Internal Medicine. “We identified a clear dose–response relationship between this widely used treatment and long-term risk of death from solid cancer, including breast cancer, in the largest cohort study to date of patients treated for hyperthyroidism,” said Cari Kitahara, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, lead author of the study. “We estimated that for every 1,000 patients treated currently using a standard range of doses, about 20 to 30 additional solid cancer deaths would occur as a result of the radiation exposure.” RAI, which has been used widely in the United States for the treatment of hyperthyroidism since the 1940s, is one of three commonly used treatments for hyperthyroidism. The other two are anti-thyroid drugs, which have been rising in popularity, and surgical treatment, which is used least often. The new findings are from a long-term follow-up study of a large cohort of people with hyperthyroidism (mainly Graves’ disease) who were treated with radiation between 1946 and 1964, the Cooperative Thyrotoxicosis Therapy Follow-up Study. In the new analysis—which included nearly 19,000 people from the original cohort, all of whom had received RAI and none of whom had had cancer at study entry—the researchers used a novel, comprehensive method of estimating radiation doses to each organ or tissue. Most of the radiation is absorbed by the thyroid gland, but other organs like the breast and stomach are also exposed during treatment. The researchers observed positive dose–response relationships between the dose absorbed by an organ and mortality from cancer at that site. The relationship was statistically significant for female breast cancer, for which every 100 milligray (mGy) of dose led to a 12% increased relative risk of breast cancer mortality, and for all other solid tumors considered together, for which relative risk of mortality was increased by 5% per every 100 mGy. Based on these findings, the researchers estimated that for every 1,000 patients aged 40 years with hyperthyroidism who were treated with the radiation doses typical of current treatment, a lifetime excess of 19 to 32 radiation-attributable solid cancer deaths would be expected. According to the researchers, in the United States, about 1.2% of the population has hyperthyroidism, and women are much more likely to develop the condition than men. Therefore, the findings for breast cancer mortality are particularly relevant for the large population of women treated for hyperthyroidism, Dr. Kitahara said. “We found the increased risks of death from solid cancer overall and from breast cancer more specifically to be modest, but RAI is still a widely used treatment for hyperthyroidism,” she said. “It’s important for patients and their physicians to discuss the risks and benefits of each available treatment option. The results of our study may contribute to these discussions.” The researchers wrote that additional research is needed to more comprehensively assess the risk–benefit ratio of radiation versus other available treatment options for hyperthyroidism. Furthermore, because the types of anti-thyroid drugs administered to patients in the original cohort were different from those prescribed more recently, the researchers wrote that more studies are needed to evaluate long-term health effects of current anti-thyroid drugs, including in comparison to RAI treatment. About the National Cancer Institute (NCI): NCI leads the National Cancer Program and NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at cancer.gov or call NCI’s contact center, the Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237). About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih.gov. |
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