A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors.
BACKGROUND
For women with differentiated thyroid carcinoma (DTC), the effect of radioactive iodine (RAI) therapy on gonadal and reproductive function is an important consideration.


OBJECTIVE
We systematically reviewed controlled studies examining the gonadal and reproductive effects of RAI therapy in women and adolescents surviving DTC. We searched nine electronic databases. All abstracts and papers were independently reviewed by two reviewers.


RESULTS
After reviewing 349 unique citations and 61 full-text papers, 16 papers including data from 3023 women or adolescents with DTC were included. All studies were observational, with no long-term randomized control trial data. The age at first RAI treatment varied from 8 to 50 years and the cumulative activities of RAI administered for treatment varied from 30 to 1099 mCi. Transient absence of menstrual periods occurred in 8-27% of women within the first year after RAI, particularly in older women. In addition, RAI-treated women experienced menopause at a slightly younger age than women not treated with RAI. In the first year after RAI therapy, several studies reported increased rates of spontaneous and induced abortions. However, RAI treatment for DTC was generally not associated with a significantly increased risk of long-term infertility, miscarriage, induced abortions, stillbirths, or offspring neonatal mortality or congenital defects.


CONCLUSIONS
In female survivors of DTC, there is little observational evidence to suggest important adverse effects of RAI treatment on gonadal function, fertility or pregnancy outcomes beyond 12 months, with the exception of a possible slightly earlier age of menopause.
Sawka
Anna M
AM
Division of Endocrinology, Department of Medicine, University Health Network Toronto, Ontario, Canada. sawkaam@yahoo.com
Lakra
Deepak C
DC
Lea
Jane
J
Alshehri
Bandar
B
Tsang
Richard W
RW
Brierley
James D
JD
Straus
Sharon
S
Thabane
Lehana
L
Gafni
Amiram
A
Ezzat
Shereen
S
George
Susan R
SR
Goldstein
David P
DP
D000465:Algorithms; D002277:Carcinoma / Q000503:physiopathology / Q000532:radiotherapy* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010053:Ovary / Q000502:physiology / Q000528:radiation effects*; D011247:Pregnancy / Q000528:radiation effects*; D017741:Survivors; D013964:Thyroid Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000534:rehabilitation
D007457:Iodine Radioisotopes