A case of esophageal stricture after iodine 131 ablation.
OBJECTIVE
To report the first case of esophageal stricture as a complication of radioiodine (¹³¹I) ablation therapy.


METHODS
We review the medical and surgical history of this patient and discuss various potential causes of the esophageal stricture.


RESULTS
A 79-year-old woman presented with increasing dysphagia and weight loss of about 4.5 kg after recent ¹³¹I therapy for thyroid cancer remnant ablation. Her pertinent history included gastroesophageal reflux disease, an anterior midcervical esophageal web, and a distal esophageal stricture. She also had a history of radiation therapy to her chest for breast cancer about 28 years previously. On the day of ¹³¹I therapy, the 5.5-GBq ¹³¹I capsule lodged accidentally in her midcervical area for approximately 2.5 hours. The resulting radiation dose to the proximal esophagus was estimated to be 7.86 Gy from gamma radiation and possibly as high as several thousand grays from beta radiation. During this time, the esophagus had possible direct exposure to the sodium phosphate dibasic that was used as filler in the sodium iodide capsule. Because of the worsening dysphagia, an esophagogastroduodenoscopy was performed 4 weeks after the ¹³¹I therapy, which showed a new proximal esophageal stricture.


CONCLUSIONS
We believe that the additional localized radiation and sodium phosphate exposure from the lodging of the ¹³¹I capsule may have contributed to the development of a proximal esophageal stricture. To our knowledge, such an occurrence has not previously been described in the medical literature. For prevention of such an occurrence, we recommend a careful swallowing evaluation of patients with any history of esophageal radiation exposure, dysphagia, or esophageal strictures before administration of ¹³¹I in capsule form. Alternative methods of ¹³¹I delivery, if available, should be considered.
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA.
Tae H
TH
Lee
Abid
A
Yaqub
James
J
Norweck
Monjur
M
Ahmed
D000368:Aged; D002214:Capsules; D003680:Deglutition Disorders / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D004106:Dilatation; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects; D005079:Excipients / Q000009:adverse effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007457:Iodine Radioisotopes; D010710:Phosphates / Q000009:adverse effects; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D019275:Radiopharmaceuticals / Q000009:adverse effects* / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects*; D012008:Recurrence; D012720:Severity of Illness Index; D013964:Thyroid Neoplasms / Q000150:complications* / Q000532:radiotherapy; D016896:Treatment Outcome
D002214:Capsules; D005079:Excipients; D007457:Iodine Radioisotopes; D010710:Phosphates; D019275:Radiopharmaceuticals; C018279:sodium phosphate