Long-Term Effects of Radioiodine Treatment on Female Fertility in Survivors of Childhood Differentiated Thyroid Carcinoma
Nies, Marloes; Cantineau, Astrid E P; Arts, Eus G J M; van den Berg, Marleen H; van Leeuwen, Flora E; Muller Kobold, Anneke C; Klein Hesselink, Mariëlle Sanne; Burgerhof, Johannes G M; Brouwers, Adrienne H; van Dam, Eveline W C M; Havekes, Bas; van den Heuvel-Eibrink, Marry M; Corssmit, Eleonora P M; Kremer, Leontien C M; Netea-Maier, Romana; van der Pal, Heleen J H; Peeters, Robin P; Plukker, John Th M; Ronckers, Cecile M; van Santen, Hanneke M; van der Horst-Schrivers, Anouk N A; Tissing, Wim J E; Bocca, Gianni; van Dulmen-den Broeder, Eline; Links, Thera P
(2020) Thyroid, volume 30, issue 8, pp. 1169 - 1176
(Article)
Abstract
Background: Differentiated thyroid carcinoma (DTC) during childhood is a rare disease. Its excellent survival rate requires a focus on possible long-term adverse effects. This study aimed to evaluate fertility in female survivors of childhood DTC by assessing various reproductive characteristics combined with anti-Müllerian hormone (AMH) levels (a marker of ovarian
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reserve). Methods: Female survivors of childhood DTC, diagnosed at ≤18 years of age between 1970 and 2013, were included. Survivors were excluded when follow-up time was less than five years or if they developed other malignancies before or after diagnosis of DTC. Survivors filled out a questionnaire regarding reproductive characteristics (e.g., age at menarche and menopause, pregnancies, pregnancy outcomes, need for assisted reproductive therapy). Survivors aged <18 years during evaluation received an altered questionnaire without questions regarding pregnancy and pregnancy outcomes. These data were combined with information from medical records. AMH levels were measured in serum samples and were compared with AMH levels from 420 women not treated for cancer. Results: Fifty-six survivors with a median age of 31.0 (interquartile range, IQR, 25.1-39.6) years were evaluated after a median follow-up of 15.4 (IQR 8.3-24.7) years. The median cumulative dose of 131I administered was 7.4 (IQR 3.7-13.0) GBq/200.0 (IQR 100.0-350.0) mCi. Twenty-five of the 55 survivors aged 18 years or older during evaluation reported 64 pregnancies, 45 of which resulted in live birth. Of these 55, 10.9% visited a fertility clinic. None of the survivors reported premature menopause. Age at AMH evaluation did not differ between DTC survivors and the comparison group ( p = 0.268). Median AMH levels did not differ between DTC survivors and the comparison group [2.0 (IQR 1.0-3.7) μg/L vs. 1.6 (IQR 0.6-3.1) μg/L, respectively, p = 0.244]. The cumulative dose of 131I was not associated with AMH levels in DTC survivors ( r s = 0.210, p = 0.130). Conclusions: Female survivors of DTC who received 131I treatment during childhood do not appear to have major abnormalities in reproductive characteristics nor in predictors of ovarian failure.
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Keywords: differentiated thyroid carcinoma, childhood cancer, adverse effects, fertility, radioiodine, Endocrinology, Endocrinology, Diabetes and Metabolism, Journal Article
ISSN: 1050-7256
Publisher: Mary Ann Liebert Inc.
Note: Funding Information: This work was supported by the Stichting Kinderen Kankervrij (Foundation Children Cancer-free, The Netherlands, project no. 81). C.M.R. is supported by the Dutch Cancer Society. Publisher Copyright: © Copyright 2020, Mary Ann Liebert, Inc., publishers 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
(Peer reviewed)