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Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

BACKGROUND: Due to the alarming increase in the incidence of thyroid cancer worldwide, more patients are receiving postoperative radioactive iodine (RAI) therapy and these patients are given a low-iodine diet along with levothyroxine withdrawal to induce a hypothyroid state to maximize the uptake of...

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Autores principales: Lee, Jung Eun, Kim, Seung Kyu, Han, Kyung Hwa, Cho, Mi Ok, Yun, Gi Young, Kim, Ki Hyun, Choi, Hoon Young, Ryu, Young Hoon, Ha, Sung Kyu, Park, Hyeong Cheon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149575/
https://www.ncbi.nlm.nih.gov/pubmed/25170831
http://dx.doi.org/10.1371/journal.pone.0106840
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author Lee, Jung Eun
Kim, Seung Kyu
Han, Kyung Hwa
Cho, Mi Ok
Yun, Gi Young
Kim, Ki Hyun
Choi, Hoon Young
Ryu, Young Hoon
Ha, Sung Kyu
Park, Hyeong Cheon
author_facet Lee, Jung Eun
Kim, Seung Kyu
Han, Kyung Hwa
Cho, Mi Ok
Yun, Gi Young
Kim, Ki Hyun
Choi, Hoon Young
Ryu, Young Hoon
Ha, Sung Kyu
Park, Hyeong Cheon
author_sort Lee, Jung Eun
collection PubMed
description BACKGROUND: Due to the alarming increase in the incidence of thyroid cancer worldwide, more patients are receiving postoperative radioactive iodine (RAI) therapy and these patients are given a low-iodine diet along with levothyroxine withdrawal to induce a hypothyroid state to maximize the uptake of RAI by thyroid tissues. Recently, the reported cases of patients suffering from life-threatening severe hyponatremia following postoperative RAI therapy have increased. This study aimed to systematically assess risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients. METHODS: We reviewed the medical records of all thyroid cancer patients who underwent thyroidectomy and postoperative RAI therapy from July 2009 to February 2012. Demographic and biochemical parameters including serum sodium and thyroid function tests were assessed along with medication history. RESULTS: A total of 2229 patients (47.0±11.0 years, female 76.3%) were enrolled in the analysis. Three hundred seven patients (13.8%) of all patients developed hyponatremia; 44 patients (2.0%) developed moderate to severe hyponatremia (serum Na(+)≤130 mEq/L) and another 263 (11.8%) patients showed mild hyponatremia (130 mEq/L<serum Na(+)≤135 mEq/L). In univariate analysis, old age, female sex, presence of hypertension, presence of diabetes, use of thiazide diuretics, use of angiotensin receptor blocker or angiotensin-converting enzyme inhibitors, lung metastasis, and hyponatremia and lower estimated glomerular filtration rate at the start of RAI therapy were significantly associated with hyponatremia in patients undergoing RAI therapy after total thyroidectomy. Multivariate analysis showed that old age, female sex, use of thiazide diuretics, and hyponatremia at the initiation of RAI therapy were independent risk factors for the development of hyponatremia. CONCLUSION: Our data suggest that age greater than 60 years, female sex, use of thiazide, and hyponatremia at the initiation of RAI therapy are important risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients.
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spelling pubmed-41495752014-09-03 Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy Lee, Jung Eun Kim, Seung Kyu Han, Kyung Hwa Cho, Mi Ok Yun, Gi Young Kim, Ki Hyun Choi, Hoon Young Ryu, Young Hoon Ha, Sung Kyu Park, Hyeong Cheon PLoS One Research Article BACKGROUND: Due to the alarming increase in the incidence of thyroid cancer worldwide, more patients are receiving postoperative radioactive iodine (RAI) therapy and these patients are given a low-iodine diet along with levothyroxine withdrawal to induce a hypothyroid state to maximize the uptake of RAI by thyroid tissues. Recently, the reported cases of patients suffering from life-threatening severe hyponatremia following postoperative RAI therapy have increased. This study aimed to systematically assess risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients. METHODS: We reviewed the medical records of all thyroid cancer patients who underwent thyroidectomy and postoperative RAI therapy from July 2009 to February 2012. Demographic and biochemical parameters including serum sodium and thyroid function tests were assessed along with medication history. RESULTS: A total of 2229 patients (47.0±11.0 years, female 76.3%) were enrolled in the analysis. Three hundred seven patients (13.8%) of all patients developed hyponatremia; 44 patients (2.0%) developed moderate to severe hyponatremia (serum Na(+)≤130 mEq/L) and another 263 (11.8%) patients showed mild hyponatremia (130 mEq/L<serum Na(+)≤135 mEq/L). In univariate analysis, old age, female sex, presence of hypertension, presence of diabetes, use of thiazide diuretics, use of angiotensin receptor blocker or angiotensin-converting enzyme inhibitors, lung metastasis, and hyponatremia and lower estimated glomerular filtration rate at the start of RAI therapy were significantly associated with hyponatremia in patients undergoing RAI therapy after total thyroidectomy. Multivariate analysis showed that old age, female sex, use of thiazide diuretics, and hyponatremia at the initiation of RAI therapy were independent risk factors for the development of hyponatremia. CONCLUSION: Our data suggest that age greater than 60 years, female sex, use of thiazide, and hyponatremia at the initiation of RAI therapy are important risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients. Public Library of Science 2014-08-29 /pmc/articles/PMC4149575/ /pubmed/25170831 http://dx.doi.org/10.1371/journal.pone.0106840 Text en © 2014 Lee et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Lee, Jung Eun
Kim, Seung Kyu
Han, Kyung Hwa
Cho, Mi Ok
Yun, Gi Young
Kim, Ki Hyun
Choi, Hoon Young
Ryu, Young Hoon
Ha, Sung Kyu
Park, Hyeong Cheon
Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title_full Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title_fullStr Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title_full_unstemmed Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title_short Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy
title_sort risk factors for developing hyponatremia in thyroid cancer patients undergoing radioactive iodine therapy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149575/
https://www.ncbi.nlm.nih.gov/pubmed/25170831
http://dx.doi.org/10.1371/journal.pone.0106840
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