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Takata N, Miyagawa M, Okada T, Kawaguchi N, Fujimoto Y, Kouchi Y, Tsuruoka S, Uwatsu K, Kido T. Effect of preparation method for radioactive iodine therapy on serum electrolytes. Jpn J Radiol 2023; 41:1247-1254. [PMID: 37184818 PMCID: PMC10613591 DOI: 10.1007/s11604-023-01444-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Thyroid hormone withdrawal (THW) in preparation for radioactive iodine therapy (RIT) may lead to hyponatremia and hyperkalemia because hypothyroidism reduces the glomerular filtration rate. Using recombinant human thyrotropin (rhTSH) may avoid these changes; however, these two preparation methods have not been compared in the literature. The purpose of this study was to reveal whether THW and rhTSH as preparation methods for RIT affect serum electrolytes differently. We also evaluated clinical factors influencing the onset of hyponatremia and hyperkalemia during RIT. MATERIALS AND METHODS From April 2005 to December 2020, we analyzed 278 patients with thyroid cancer who received RIT. The patients were classified into two groups based on the preparation method, and renal function and serum electrolytes were compared between the groups. We also evaluated clinical factors that may affect overt hyponatremia (serum sodium level < 134 mmol/L) and hyperkalemia (serum potassium level ≥ 5.0 mmol/L). RESULTS Serum sodium and chloride levels in the THW group were significantly lower than those in the rhTSH group (p < 0.001 and p = 0.002, respectively). In contrast, the serum potassium level in the THW group was significantly higher than that in the rhTSH group (p = 0.008). As for clinical factors that may influence hyponatremia, age and estimated glomerular filtration rate (eGFR) were significantly associated with serum sodium level in the univariate analysis (p = 0.033 and p = 0.006, respectively). In the multivariate analysis, only age was significantly associated with serum sodium level (p = 0.030). Regarding hyperkalemia, distant metastases, the preparation method and eGFR were significantly associated with the serum potassium level in the univariate analysis (p = 0.005, p = 0.005 and p = 0.001, respectively). In the multivariate analysis, only eGFR was significantly associated with hyperkalemia (p = 0.019). CONCLUSION THW and rhTSH affect serum sodium and potassium levels differently. Renal function may be risk factors for hyperkalemia, whereas older age may be a risk factor for hyponatremia.
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Affiliation(s)
- Noriko Takata
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan.
| | - Masao Miyagawa
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Tomohisa Okada
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Yutaka Fujimoto
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Yoshihiro Kouchi
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Kotaro Uwatsu
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
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Herbert G, England C, Perry R, Whitmarsh A, Moore T, Searle A, Chotaliya S, Ness A, Beasley M, Atkinson C. Impact of low iodine diets on ablation success in differentiated thyroid cancer: A mixed-methods systematic review and meta-analysis. Clin Endocrinol (Oxf) 2022; 97:702-729. [PMID: 35484696 PMCID: PMC9790217 DOI: 10.1111/cen.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Debate remains regarding whether to recommend a low iodine diet (LID) before radioactive-iodine treatment and its duration and stringency. This mixed-methods review aimed to determine if iodine status affects treatment success, the most effective diet to reduce iodine status, and how LID impacts wellbeing. METHODS Five electronic databases were searched until February 2021. An effectiveness synthesis (quantitative studies) and views synthesis (qualitative, survey, and experience-based evidence) were conducted individually and then integrated. Quality assessment was undertaken. RESULTS Fifty-six quantitative and three qualitative studies were identified. There was greater ablation success for those with an iodine status of <50 mcg/L (or mcg/gCr) compared with ≥250 (odds ratio [OR] = 2.63, 95% confidence interval [CI], 1.18-5.86, n = 283, GRADE certainty of evidence very low). One study compared <50 mcg/L (or mcg/gCr) to 100-199 and showed similar rates of ablation success (OR = 1.59, 95% CI, 0.48-6.15, n = 113; moderate risk of bias). People following a stricter LID before ablation had similar rates of success to a less-strict diet (OR = 0.67, 95% CI, 0.26-1.73, n = 256, GRADE certainty of evidence very low). A stricter LID reduced iodine status more than a less strict (SMD = -0.40, 95% CI, -0.56 to -0.24, n = 816), and reduction was seen after 1 and 2 weeks. The main challenges were a negative impact on psychological health, over restriction, confusion, and difficulty for sub-groups. CONCLUSIONS Although a LID of 1-2 weeks reduces iodine status, it remains unclear whether iodine status affects treatment success as only a few low-quality studies have examined this. LIDs are challenging for patients. Higher-quality studies are needed to confirm whether a LID is necessary.
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Affiliation(s)
- Georgia Herbert
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Rachel Perry
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Alex Whitmarsh
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Theresa Moore
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | | | - Andy Ness
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Matthew Beasley
- University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
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Dekker BL, Links MH, Muller Kobold AC, Swart-Busscher LG, Kars M, Bons JAP, Brouwers AH, Links TP, van der Horst-Schrivers ANA. Low-Iodine Diet of 4 Days Is Sufficient Preparation for 131I Therapy in Differentiated Thyroid Cancer Patients. J Clin Endocrinol Metab 2022; 107:e604-e611. [PMID: 34534327 PMCID: PMC8764339 DOI: 10.1210/clinem/dgab691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/29/2022]
Abstract
CONTEXT No consensus exists about the optimal duration of the low-iodine diet (LID) in the preparation of 131I therapy in differentiated thyroid cancer (DTC) patients. OBJECTIVE This work aimed to investigate if a LID of 4 days is enough to achieve adequate iodine depletion in preparation for 131I therapy. In addition, the nutritional status of the LID was evaluated. METHODS In this prospective study, 65 DTC patients treated at 2 university medical centers were included between 2018 and 2021. The patients collected 24-hour urine on days 4 and 7 of the LID and kept a food diary before and during the LID. The primary outcome was the difference between the 24-hour urinary iodine excretion (UIE) on both days. RESULTS The median 24-hour UIE on days 4 and 7 of the LID were not significantly different (36.1 mcg [interquartile range, 25.4-51.2 mcg] and 36.5 mcg [interquartile range, 23.9-47.7 mcg], respectively, P = .43). On day 4 of the LID, 72.1% of the DTC patients were adequately prepared (24-hour UIE < 50 mcg), and 82.0% of the DTC patients on day 7 (P = .18). Compared to the self-reported regular diet, DTC patients showed a significantly (P < .01) lower percentage of nutrient intake (calories, protein, calcium, iodine, and water) during the LID. CONCLUSION The 24-hour UIE on day 4 of the LID did not differ from day 7, and therefore shortening the LID from 7 to 4 days seems justified to prepare DTC patients for 131I therapy in areas with sufficient iodine intake and may be beneficial to maintain a sufficient nutritional intake during DTC treatment.
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Affiliation(s)
- Bernadette L Dekker
- University of Groningen, University Medical Center Groningen, Internal Medicine, Department of Endocrinology, 9700 RB Groningen, the Netherlands
| | - Mirthe H Links
- University of Groningen, University Medical Center Groningen, Internal Medicine, Department of Endocrinology, 9700 RB Groningen, the Netherlands
| | - Anneke C Muller Kobold
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, 9700 RB Groningen, the Netherlands
| | - Linda G Swart-Busscher
- University of Groningen, University Medical Center Groningen, Department of Paramedical Sciences, 9700 RB Groningen, the Netherlands
| | - Marleen Kars
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Adrienne H Brouwers
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, 9700 RB Groningen, the Netherlands
| | - Thera P Links
- University of Groningen, University Medical Center Groningen, Internal Medicine, Department of Endocrinology, 9700 RB Groningen, the Netherlands
| | - Anouk N A van der Horst-Schrivers
- University of Groningen, University Medical Center Groningen, Internal Medicine, Department of Endocrinology, 9700 RB Groningen, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
- Correspondence: Anouk N. A. van der Horst-Schrivers, MD, PhD, Maastricht University Medical Center, Division of Endocrinology, Postbus 5800, 6202 AZ, Maastricht, the Netherlands.
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Niri T, Horie I, Ando T, Kawahara H, Ueda M, Eto M, Sako A, Ikeuchi Y, Nakao T, Nakashima Y, Shigeno R, Ito A, Nozaki A, Haraguchi A, Natsuda S, Sagara I, Akazawa S, Kamada A, Imaizumi M, Abiru N, Usa T, Kawakami A. RENAL FUNCTION AND PLASMA RENIN ACTIVITY AS POTENTIAL FACTORS CAUSING HYPERKALEMIA IN PATIENTS WITH THYROID CARCINOMA UNDERGOING THYROID HORMONE WITHDRAWAL FOR RADIOACTIVE IODINE THERAPY. Endocr Pract 2020; 26:197-206. [PMID: 31652100 DOI: 10.4158/ep-2019-0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Hypothyroidism is not commonly considered a cause of hyperkalemia. We previously reported that hyperkalemia was observed mainly in elderly patients treated with renin-angiotensin-aldosterone system (RAS) inhibitors when levothyroxine treatment was withdrawn for the thyroidectomized patients with thyroid carcinoma to undergo radioactive iodine treatment. Here, we investigated whether acute hypothyroidism causes hyperkalemia in patients who were not treated with RAS inhibitors. We also investigated factors influencing potassium metabolism in hypothyroid patients. Methods: We conducted a single-center, prospective cohort study of 46 Japanese patients with thyroid carcinoma undergoing levothyroxine withdrawal prior to radioiodine therapy. All patients were normokalemic before levothyroxine withdrawal. Blood samples were analyzed 3 times: before, and at 3 and 4 weeks after levothyroxine withdrawal. We investigated factors that may be associated with the elevation of serum potassium levels from a euthyroid state to a hypothyroid state. Results: None of the patients developed symptomatic hyperkalemia. The mean serum potassium level was significantly higher at 4 weeks after levothyroxine withdrawal compared to baseline. The serum sodium levels, the estimated glomerular filtration rate (eGFR), and the plasma renin activity (PRA) decreased significantly as hypothyroidism advanced. In contrast, the plasma levels of adrenocorticotropic hormone, cortisol, aldosterone, and antidiuretic hormone were not changed, while serum thyroid hormone decreased. At 4 weeks after their levothyroxine withdrawal, the patients' serum potassium values were significantly correlated with the eGFR and the PRA. Conclusion: Acute hypothyroidism can cause a significant increase in the serum potassium level, which may be associated with a decreased eGFR and decreased circulating RAS. Abbreviations: ACTH = adrenocorticotropic hormone; ADH = antidiuretic hormone; ATPase = adenosine triphosphatase; eGFR = estimated glomerular filtration rate; HbA1c = glycated hemoglobin; K+ = potassium; Na+ = sodium; PRA = plasma renin activity; RAS = renin-angiotensin-aldosterone system; T4 = thyroxine; TSH = thyroid-stimulating hormone.
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Kim J, Cho SG, Kang SR, Kwon SY, Cho DH, Cho JS, Song HC. Preparation for radioactive iodine therapy is not a risk factor for the development of hyponatremia in thyroid cancer patients. Medicine (Baltimore) 2017; 96:e6004. [PMID: 28151897 PMCID: PMC5293460 DOI: 10.1097/md.0000000000006004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to evaluate whether the preparation for radioactive iodine (RAI) therapy by thyroid hormone withdrawal (THW) or a low-iodine diet (LID) can be risk factors for the development of hyponatremia in patients with differentiated thyroid cancer after thyroidectomy.We retrospectively reviewed the medical records and laboratory findings of 326 patients who underwent preparation for RAI therapy after thyroidectomy from 2012 to 2014. Demographic and clinical variables including the method of thyrotropin stimulation and duration of LID were assessed. Serum sodium was measured twice, before operation and before RAI therapy.Hyponatremia was detected in only 3 patients (0.9%) before operation, but in 15 patients (4.6%) before RAI therapy. None of the patients had severe hyponatremia after preparation for RAI therapy. Pre-RAI therapy serum sodium was correlated with the method of thyrotropin stimulation (TWH vs recombinant human thyroid stimulating hormone, P = 0.014) and duration of LID (r = -0.131, P = 0.018); however, the preparation of RAI therapy, THW and LID, did not affect the development of hyponatremia in logistic regression analysis. Preoperative serum sodium was a significant risk factor for hyponatremia during preparation for RAI therapy.Preparation for RAI therapy by THW or LID is not a risk factor for the development of hyponatremia in patients with thyroid cancer. The development of hyponatremia was neither frequent nor severe during preparation for RAI therapy. Physicians should not be greatly concerned about rare life-threatening hyponatremia during preparation for RAI therapy.
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Affiliation(s)
- Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital
| | - Dong-Hyeok Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Hospital
| | - Jin-Seong Cho
- Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital
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Liamis G, Filippatos TD, Liontos A, Elisaf MS. MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol 2017; 176:R15-R20. [PMID: 27484454 DOI: 10.1530/eje-16-0493] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/06/2016] [Accepted: 08/01/2016] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- G Liamis
- Department of Internal MedicineSchool of Medicine, University of Ioannina, Ioannina, Greece
| | - T D Filippatos
- Department of Internal MedicineSchool of Medicine, University of Ioannina, Ioannina, Greece
| | - A Liontos
- Department of Internal MedicineSchool of Medicine, University of Ioannina, Ioannina, Greece
| | - M S Elisaf
- Department of Internal MedicineSchool of Medicine, University of Ioannina, Ioannina, Greece
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Dayrit JCP, Cunanan EC, Kho SA. Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience. Endocrinol Metab (Seoul) 2016; 31:410-415. [PMID: 27546873 PMCID: PMC5053053 DOI: 10.3803/enm.2016.31.3.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/31/2016] [Accepted: 07/18/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established. METHODS Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age. RESULTS Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age. CONCLUSIONS The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.
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Affiliation(s)
- Juan Carlo P Dayrit
- Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - Elaine C Cunanan
- Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Sjoberg A Kho
- Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines
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Cuesta M, Garrahy A, Thompson CJ. SIAD: practical recommendations for diagnosis and management. J Endocrinol Invest 2016; 39:991-1001. [PMID: 27094044 DOI: 10.1007/s40618-016-0463-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 12/26/2022]
Abstract
Hyponatremia is the commonest electrolyte disturbance encountered in hospitalized patients, and the syndrome of inappropriate antidiuresis (SIAD) is the most frequent underlying disorder. There is a well-recognized relationship between hyponatremia and increased morbidity and mortality. Therefore, to provide appropriate treatment is critical to improve the clinical outcome related to SIAD-hyponatremia. There have been important advances in the treatment of SIAD over the last decade, leading to the publication of several clinical guidelines. In particular, the introduction of the vasopressin-2 receptor antagonists provides a potent pharmacological tool to target the underlying pathophysiology of SIAD. The evidence base recommendations of the available therapies for SIAD are discussed in this study. Fluid restriction is considered the first-line therapy by the recent published guidelines, but it is certainly ineffective or unfeasible in many patients with SIAD. We discuss a number of relevant points to the use of fluid restriction in this study, including the lack of good evidence-based recommendations to support its use. Conversely, the clinical efficacy of oral tolvaptan in SIAD supported by good quality randomized, placebo controlled, clinical trials. However, the cost of the therapy and the need for long-term safety data may limit its widespread use. Finally, new recommendations for the management of acute hyponatremia with a focus on the use of bolus therapy with 3 % hypertonic sodium chloride are described in this study.
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Affiliation(s)
- M Cuesta
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland
| | - A Garrahy
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland
| | - C J Thompson
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland.
- Beaumont Private Clinic, Beaumont Hospital, Dublin 9, Ireland.
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9
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Li JH, He ZH, Bansal V, Hennessey JV. Low iodine diet in differentiated thyroid cancer: a review. Clin Endocrinol (Oxf) 2016; 84:3-12. [PMID: 26118628 DOI: 10.1111/cen.12846] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/23/2015] [Accepted: 06/23/2015] [Indexed: 12/23/2022]
Abstract
Radioactive iodine (RAI) ablation is a beneficial, adjuvant therapy for the management of differentiated thyroid cancer (DTC) after thyroidectomy. The goal of RAI is to destroy remnant thyroid and microscopic cancerous tissue. Radioactive iodine uptake is enhanced by elevating TSH levels and initiating a low iodine diet (LID) prior to ablation. An ideal LID should preferably not exceed 50 mcg/day of dietary iodine for 1-2 weeks, although the duration may be shortened to a week with a structured patient education programme. A pre-ablation spot urinary iodine concentration (UIC) of <100 mcg/l and/or a urinary iodine to creatinine ratio (UICR) of <100 mcg/gCr would support an adequate LID preparation. Hyponatraemia, most likely due to iatrogenic hypothyroidism, is a potential side effect associated with LID and occurs during and a few days after the LID. Although the overall incidence of hyponatraemia is low, patients at high risk (older age, female sex, use of thiazide diuretics) may benefit from serum sodium monitoring. The existing evidence on the impact of LID on RAI ablation has been largely inconsistent due to retrospective study designs and the lack of an objective measurement of urinary iodine levels. Future large prospective randomized control trials are needed to elucidate and confirm the crucial role of LID in achieving successful RAI ablation and greater disease-free survival in DTC.
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Affiliation(s)
- Josephine H Li
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Zhiheng H He
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - Vivek Bansal
- Division of Clinical and Molecular Endocrinology, Department of Medicine, University Hospitals/Case Medical Center, Cleveland, OH, USA
| | - James V Hennessey
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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10
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Ju DL, Park YJ, Paik HY, Kim MJ, Park S, Jung KY, Kim TH, Choi HS, Song YJ. Dietary evaluation of a low-iodine diet in Korean thyroid cancer patients preparing for radioactive iodine therapy in an iodine-rich region. Nutr Res Pract 2015; 10:167-74. [PMID: 27087900 PMCID: PMC4819127 DOI: 10.4162/nrp.2016.10.2.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES Despite the importance of a low-iodine diet (LID) for thyroid cancer patients preparing for radioactive iodine (RAI) therapy, few studies have evaluated dietary intake during LID. This study evaluated the amount of dietary iodine intake and its major food sources during a typical diet and during LID periods for thyroid cancer patients preparing for RAI therapy, and examined how the type of nutrition education of LID affects iodine intake. SUBJECTS/METHODS A total of 92 differentiated thyroid cancer patients with total thyroidectomy were enrolled from Seoul National University Hospital. All subjects completed three days of dietary records during usual and low-iodine diets before 131I administration. RESULTS The median iodine intake was 290 µg/day on the usual diet and 63.2 µg/day on the LID. The major food groups during the usual diet were seaweed, salted vegetables, fish, milk, and dairy products and the consumption of these foods decreased significantly during LID. The mean energy intake on the LID was 1,325 kcal, which was 446 kcal lower than on the usual diet (1,771 kcal). By avoiding iodine, the intake of most other nutrients, including sodium, was significantly reduced during LID (P < 0.005). Regarding nutritional education, intensive education was more effective than a simple education at reducing iodine intake. CONCLUSION Iodine intake for thyroid cancer patients was significantly reduced during LID and was within the recommended amount. However, the intake of most other nutrients and calories was also reduced. Future studies are needed to develop a practical dietary protocol for a LID in Korean patients.
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Affiliation(s)
- Dal Lae Ju
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, 03080, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Hee-Young Paik
- Department of Food and Nutrition, Seoul National University, Seoul, 08826, Korea
| | - Min-Ji Kim
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi 14662, Korea
| | - Seonyeong Park
- Department of Internal Medicine, Seoul National University Hospital Biomedical Research Institute, Seoul, 03080, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Eulji University Hospital, Seoul, 01830, Korea
| | - Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.; Department of Internal Medicine, Thyroid Center, Samsung Medical Center, Seoul, 06351, Korea
| | - Hun Sung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.; Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, 24289, Korea
| | - Yoon Ju Song
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi 14662, Korea
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Horie I, Ando T, Imaizumi M, Usa T, Kawakami A. Hyperkalemia develops in some thyroidectomized patients undergoing thyroid hormone withdrawal in preparation for radioactive iodine ablation for thyroid carcinoma. Endocr Pract 2015; 21:488-94. [PMID: 25667379 DOI: 10.4158/ep14532.or] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hyponatremia is observed in hypothyroidism, but it is not known if hypo- or hyperkalemia is associated with hypothyroidism. To study these questions, we determined serum potassium (K(+)) levels in thyroidectomized patients undergoing levothyroxine withdrawal before radioactive iodine (RAI) therapy for thyroid carcinoma. METHODS We retrospectively studied the records of 108 patients who had undergone total thyroidectomy for thyroid carcinoma followed by levothyroxine withdrawal and then ablation with RAI at Nagasaki University Hospital from 2009-2013. Blood samples were analyzed for serum K(+) concentrations when patients were euthyroid just before levothyroxine withdrawal and hypothyroid 21 days after levothyroxine withdrawal. We determined the proportion of patients who developed hyperkalemia (K(+) ≥5 mEq/L) and hypokalemia (K(+) ≤3.5 mEq/L). RESULTS Five (4.6%) patients developed hyperkalemia and 2 (1.9%) patients developed hypokalemia after levothyroxine withdrawal. The mean serum K(+) level after levothyroxine withdrawal was significantly higher than before levothyroxine withdrawal (4.23 ± 0.50 mEq/L vs. 4.09 ± 0.34 mEq/L; P<.001). After levothyroxine withdrawal, serum K(+) values were significantly correlated with age, serum sodium and creatinine levels, and the estimated glomerular filtration rate but not with serum free thyroxine or thyroid-stimulating hormone concentrations. The finding of an elevated serum K(+) of >0.5 mEq/L after levothyroxine withdrawal was more prevalent with age >60 years (odds ratio [OR], 4.66; P = .026) and with the use of angiotensin-II receptor blockers or angiotensin-converting enzyme inhibitors (OR, 3.53; P = .033) in a multivariate analysis. CONCLUSION Hyperkalemia develops in a small percentage of hypothyroid patients after thyroid hormone withdrawal, especially in patients over 60 years of age who are using antihypertensive agents that inhibit the reninangiotensin-aldosterone system.
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12
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Pantalone KM, Hatipoglu BA. Hyponatremia and the Thyroid: Causality or Association? J Clin Med 2014; 4:32-6. [PMID: 26237016 PMCID: PMC4470237 DOI: 10.3390/jcm4010032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/05/2014] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
| | - Betul A. Hatipoglu
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-216-445-6709
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13
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Lee JE, Kim SK, Han KH, Cho MO, Yun GY, Kim KH, Choi HY, Ryu YH, Ha SK, Park HC. Risk factors for developing hyponatremia in thyroid cancer patients undergoing radioactive iodine therapy. PLoS One 2014; 9:e106840. [PMID: 25170831 PMCID: PMC4149575 DOI: 10.1371/journal.pone.0106840] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/02/2014] [Indexed: 12/28/2022] Open
Abstract
Background Due 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. Methods We 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. Results A 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<serum Na+≤135 mEq/L). In univariate analysis, old age, female sex, presence of hypertension, presence of diabetes, use of thiazide diuretics, use of angiotensin receptor blocker or angiotensin-converting enzyme inhibitors, lung metastasis, and hyponatremia and lower estimated glomerular filtration rate at the start of RAI therapy were significantly associated with hyponatremia in patients undergoing RAI therapy after total thyroidectomy. Multivariate analysis showed that old age, female sex, use of thiazide diuretics, and hyponatremia at the initiation of RAI therapy were independent risk factors for the development of hyponatremia. Conclusion Our data suggest that age greater than 60 years, female sex, use of thiazide, and hyponatremia at the initiation of RAI therapy are important risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients.
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Affiliation(s)
- Jung Eun Lee
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Kyu Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Gangnam Medical Research Center, Seoul, Republic of Korea
| | - Mi Ok Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gi Young Yun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon Young Choi
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kyu Ha
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Cheon Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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14
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Jo HJ, Kim YH, Shin DH, Kim MJ, Lee SJ, Jeon DO, Im SG, Jang SK, Choi JY. Hyponatremia after thyroid hormone withdrawal in a patient with papillary thyroid carcinoma. Endocrinol Metab (Seoul) 2014; 29:77-82. [PMID: 24741458 PMCID: PMC3970286 DOI: 10.3803/enm.2014.29.1.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/12/2013] [Indexed: 01/20/2023] Open
Abstract
Hyponatremia is an electrolyte abnormality commonly found in clinical practice. It is important to diagnose the underlying etiology of the hyponatremia and correct it appropriately because severe hyponatremia can cause serious complications and substantially increase the risk of mortality. Although hypothyroidism is known to be a cause of hyponatremia, it is rare that hyponatremia occurs in relation to hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer. We report a case of a 76-year-old woman with papillary thyroid carcinoma presenting with severe hyponatremia related to hypothyroidism induced by thyroid hormone withdrawal for radio-active iodine whole-body scanning, who was treated by thyroid hormone replacement and hydration. Considering that the incidence of differentiated thyroid cancer is rapidly increasing, physicians should be aware that, although uncommon, hyponatremia can occur in patients undergoing radioiodine therapy or diagnostic testing.
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Affiliation(s)
- Hyo Jin Jo
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Yong Hyun Kim
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Dong Hyun Shin
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Mi Jeoung Kim
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Sang Jin Lee
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Dong Ok Jeon
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Sung Gyu Im
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Sun Kyung Jang
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
| | - Jin Young Choi
- Department of Internal Medicine, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Seongnam, Korea
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