Estimates of thyroid cancer incidence in Brazil: an approach using polynomial models

Correlation among ocular surface disease, xerostomia, and nasal symptoms in patients with differentiated thyroid carcinoma subjected to radioiodine therapy: A prospective comparative study

BACKGROUND

Some complications of radioiodine therapy have been reported, but the involvement of the eyes and adnexa is rarely discussed. The purpose of this study was to determine the correlation among ocular surface changes, xerostomia, and changes in the nasal mucosa associated with radioiodine therapy.

METHODS

Patients subjected to radioiodine therapy (group 1) or not subjected (group 2) were prospectively evaluated by examinations of the ocular surface and tear film, saliva production, and nasal endoscopy. Ocular and nasal symptoms and xerostomia were evaluated using questionnaires.

RESULTS

Evaluation of the ocular surface did not indicate significant differences between the groups. Nasal endoscopy revealed higher mucosal pallor in group 1 and worsening of the endoscopic appearance. Worsening of ocular symptoms and nasal symptoms, xerostomia, and a significant decrease in salivary production was also observed in group 1.

CONCLUSION

Subjective worsening of xerostomia, xerophthalmia, nasal symptoms, and changes in the nasal mucosa in group 1 was observed.

Lacrimal System Obstruction After Radioiodine Therapy in Differentiated Thyroid Carcinomas: A Prospective Comparative Study

BACKGROUND

Radioiodine therapy (RIT) is an established treatment for differentiated thyroid carcinomas, and is widely used throughout the world, given the increasing incidence of this malignancy. Although serious adverse effects are infrequent, complications such as dry mouth, sialadenitis, and dysphagia have been described. The involvement of the eyes and accessory visual structures is not commonly discussed, despite dry eye, keratoconjunctivitis, and lacrimal system obstruction (LSO) being reported, especially after high cumulative doses of radiopharmaceuticals. The incidence of LSO is not well established.

OBJECTIVES

The aim of this study was to determine the frequency of LSO in patients undergoing RIT at 2, 4, 6, and 12 months after treatment.

METHODS

Patients with differentiated thyroid carcinoma undergoing (group 1) and not undergoing (group 2) RIT were evaluated in the preoperative and postoperative periods and 2, 4, 6, and 12 months post surgery or post RIT. Patients underwent tear film evaluation and lacrimal system probing and irrigation.

RESULTS

Group 1 (n = 44; 88 eyes) contained three patients (four eyes) with LSO, corresponding to an incidence of 4.55% (four events in 88 eyes) or 6.8% (three cases in 44 patients). Group 2 (n = 43; 86 eyes) did not present any cases of LSO.

CONCLUSIONS

In this study, an active prospective investigation allowed LSO detection during the first six months after RIT. This finding demonstrates the importance of making this association clear to patients and health professionals, with a view to early diagnosis, appropriate treatment, and preventing LSO-related complications.

Long-term follow-up of patients with differentiated thyroid cancer who had negative 131I whole-body scan at first evaluation after treatment

PURPOSE OF THE REPORT

The evaluation of patients with differentiated thyroid cancer is commonly based on serum thyroglobulin (Tg) measurement and 131I whole-body scan (WBS). The first follow-up (6-12 months after initial treatment) shows the response to therapy, a prognostic factor.The aims of the study were to describe the clinical outcome during a long-term follow-up of patients with negative 131I WBS in the first evaluation, and to assess clinical and histological characteristics related to the outcome in this patient population.

PATIENTS AND METHODS

This retrospective study reviewed data from 209 patients followed at 2 Brazilian hospitals. A minimum of 10 years of follow-up was required.

RESULTS

During mean follow-up of 13.7 ± 4.2 years, 20% of patients developed recurrence. At the end of follow-up, 21% of patients had persistent disease. The clinical and histological characteristics related to adverse outcomes (recurrence or persistent disease) were lymph node metastases at diagnosis, high risk according to American Thyroid Association (ATA) classification, and incomplete response to treatment. Stimulated Tg levels (under thyroid hormone withdrawal) and basal Tg levels (with thyroid hormone) greater than 10 ng/mL at first evaluation were associated with an adverse outcome.

CONCLUSION

Negative WBS at first evaluation should not be used as an isolated prognostic factor. This must be considered together with histopathological (ATA classification, lymph node metastases) and clinical/laboratory characteristics (stimulated and basal Tg; response to therapy).