131I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease

Purpose: Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease. Material and methods: Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014. Inclusion criteria: DTC and radioiodine treatment while on haemodialysis. Exclusion criteria: peritoneal dialysis. Results: Final sample n = 9 patients (n = 5 males), age 48 years (median age 51 years males, 67 years female group); n = 8 papillary thyroid cancer, n =1 follicular thyroid cancer; n = 5 lymph node invasion; n =1 metastatic disease. Median RAI dose administered on haemodialysis 100 mCi. 7.5 years after radioiodine treatment on haemodialysis, n = 7 deemed free of thyroid disease, n = 1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n = 4 patients underwent successful renal transplantation; n =4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease). Conclusions: Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease. (C) 2015 Elsevier Espana, S.L.U. and SEMNIM. All rights reserved.