Unexpected effect of furosemide on radioiodine urinary excretion in patients with differentiated thyroid carcinomas treated with iodine 131.
BACKGROUND
In patients receiving (131)I for therapeutic purposes, diuretics are frequently used in an attempt to accelerate elimination of unbound radioiodine, reduce its adverse effects, and shorten the hospital stay. The aims of our study were to investigate the influence of furosemide therapy on urinary excretion of (131)I in patients with differentiated thyroid cancer (DTC), referred to radioiodine ablation after thyroidectomy, and to investigate whether diuretics are useful in daily practice in patients with DTC.


METHODS
Forty-three patients with DTC who had normal renal function and low (131)I uptake in cervical region (3.55 +/- 3.45%) were included in this study. The furosemide (20 mg) and potassium chloride (250 mg) were given orally to 23 patients 3 hours after the (131)I administration, and then q8h for 3 days. Twenty patients did not receive either furosemide or potassium chloride. After (131)I administration, the patients collected their urine for 3 days, and radioactivity of urine sample from each micturition was expressed as percentage of the administered dose. Radioactivity of blood samples was measured after 72 hours, and the values were corrected for decay of (131)I and expressed in relation to the administered dose. Initial whole-body measurement (immediately after (131)I administration) and the whole-body measurement after 72 hours were recorded for all patients. The 72-hour whole-body measurement was corrected for decay of (131)I, and expressed as a percentage of the initial whole-body measurement.


RESULTS
Urinary excretion of (131)I was significantly lower in the patients who were taking furosemide and potassium chloride compared with the control group. The whole-body measurements after 72 hours (13.22 +/- 6.55% vs. 8.24 +/- 3.39% of the initial; p < 0.01, respectively) and the blood radioactivity (34.66 +/- 24.84 vs. 11.64 +/- 8.32 cpm/mL per 1 MBq of administered (131)I, p < 0.01) were found to be unexpectedly higher in the patients who were taking furosemide and potassium chloride compared with the control group.


CONCLUSIONS
Our results demonstrated that furosemide given as an adjuvant medication in patients with DTC causes a significant decrease in urinary excretion of radioiodine and its higher blood concentration. Therefore, furosemide should not be recommended as an adjuvant therapy to radioiodine ablation in patients with DTC previously iodine depleted by low-iodine diet.
Matovic
Milovan D
MD
Department of Nuclear Medicine, Clinical Center and Medical Faculty Kragujevac, Serbia. mmatovic@medf.kg.ac.rs
Jankovic
Slobodan M
SM
Jeremic
Marija
M
Tasic
Zoran
Z
Vlajkovic
Marina
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000652:urine; D004232:Diuretics / Q000494:pharmacology; D005260:Female; D005665:Furosemide / Q000494:pharmacology*; D006801:Humans; D007455:Iodine / Q000378:metabolism* / Q000652:urine*; D007457:Iodine Radioisotopes / Q000627:therapeutic use / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000494:pharmacology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000652:urine; D013997:Time Factors
D004232:Diuretics; D007457:Iodine Radioisotopes; D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide; D007455:Iodine