A Single Radioactive Iodine Treatment has a Deleterious Effect on Ovarian Reserve in Women with Thyroid Cancer: Results of a Prospective Pilot Study.

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A Single Radioactive Iodine Treatment has a Deleterious Effect on Ovarian Reserve in Women with Thyroid Cancer: Results of a Prospective Pilot Study.

Thyroid. 2018 Feb 21;:

Authors: Yaish I, Azem F, Gutfeld O, Silman Z, Serebro M, Sharon O, Shefer G, Limor R, Stern N, Tordjman KM

Abstract
BACKGROUND: Women of reproductive age with differentiated thyroid cancer (DTC) often need to receive radioactive iodine (RAI) treatment after surgery. In contrast to the well documented effect of RAI on testicular function, the potential negative effects of this treatment on ovarian reserve have been largely dismissed. The objective of this pilot study was to examine the possibility that RAI treatment is deleterious to the ovarian reserve by prospectively measuring the concentration of anti-Müllerian hormone (AMH) after this treatment.
METHODS: Thirty premenopausal women (aged 34 years, range 20-45) with a new diagnosis of DTC scheduled to undergo RAI ablation were recruited for this study. All of them had TNM stage 1 disease (T1-3, N0 or N1, M0), and were scheduled to receive RAI doses ranging from 30-150 mCi. AMH was measured at baseline, and 3, 6, 9 and 12 months after the administration of RAI.
RESULTS: Of the 30 women, only 24 returned after the baseline assessment. RAI treatment resulted in a significant decrease in AMH concentrations at 3 months, from 3.252.75 to 1.91.74 ng/ml, P<0.0001. Only partial recovery was subsequently documented, 82% of subjects had final values below baseline levels, such that at one year serum AMH was still 32% lower than prior to treatment (2.361.88 ng/ml, P<0.005). The only two continuous variables that correlated with the extent of AMH reduction at 3 months were the woman's age (r=0.51, P=0.02), and the age at menarche (r=0.48, P=0.03). Importantly, the RAI dose was not associated with the extent of AMH reduction, neither were smoking, nor the use of birth control pills. Older (>35) subjects were significantly more likely to experience a marked AMH reduction at 3 months (63.7±18.5% vs 33.1± 29.2%, P=0.01). The only predictor of recovery after 1 year was the extent of AMH decrease at 3 months: the lower the decline, the higher the chances for recovery.
CONCLUSIONS: RAI in DTC has a rapid and profound effect on ovarian reserve with only a partial recovery potential. In an era of declining human fertility, RAI should be carefully planned in women of reproductive age. AMH measurement could be used as a tool in this decision-making process.

PMID: 29466932 [PubMed - as supplied by publisher]

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