Influence Of Radioactive Iodine Ablation On Liver Function In Patients With Differentiated Thyroid Cancer

Aims: This study aimed to investigate the influence of radioactive iodine(RAI)therapy on liver function in patients with differentiated thyroid cancer(DTC),with emphasized focus on gender and accumulated dose.Methods: Liver function at baseline was compared with liver function obtained after the first RAI ablation with approximately 3700 MBq(100 mCi)dosage in 357 DTC patients(male 110,female 247).Further comparisons were done in patients with available data after regular and successive RAI therapies including 126 patients(male 37,female 89)for two RAI treatments,52 patients(male 16,female 36)for three RAI treatments,19 patients(male 5,female 14)for four RAI treatments.Analyses were performed to evaluate the potential impact of RAI on liver function,including total protein(TP),albumin(ALB),globulin(GLO),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma glutamyltransferase(GGT),lactic dehydrogenase(LDH),total bilirubin(TBIL)and direct bilirubin(DBIL)in both sexes.Continuous variables were analyzed by using nonparametric analysis.Results: Compared with the original hepatic function before the first RAI ablation,TP(75.85±4.29 versus 74.29±5.49 g/L,P<0.01),ALB(46.95±3.05 versus 46.63±3.20 g/L,p<0.05),GLO(28.95±3.75 versus 27.87±3.55 g/L,p<0.01),ALT(29.82±25.28 versus 27.11±18.29 U/L,p<0.05),ALP(63.26±18.24 versus 61.07±17.15 U/L,p<0.01)and GGT(28.33±21.82 versus 25.03±18.30 U/L,p<0.01)declined significantly after the first RAI ablation in both sexes.In both gender subgroups,TP,GLO and GGT tended to decline.ALT(39.28±24.55 versus 34.99±21.96 U/L,p<0.05),ALP(63.33±15.74 versus 59.62±14.61 U/L,p<0.01)and LDH(209.76±51.43 versus 199.71±43.50 U/L,p<0.05)showed a significant decline in male subgroup,while TBIL(9.49±4.38 versus 8.97±3.78 umol/L,p<0.05)declined significantly in female subgroup.As to the level of liver function after the second RAI therapy,TP(76.19±4.39 versus 74.56±4.02 g/L,P<0.01),GLO(29.53±3.85 versus 28.24±3.29 g/L,P<0.01),ALP(68.47±21.01 versus 65.63±21.20 U/L,p<0.01),GGT(28.98±21.47 versus 25.71±24.97 U/L,p<0.01)and DBIL(2.96±1.57 versus 3.19±1.50 umol/L,p<0.05)appeared a significant decreasing trend.In both gender subgroups,TP,GLO and GGT reduced significantly.And only ALP(67.84±15.01 versus 63.05±16.97 U/L,p<0.01)significant declined in male subgroup.As to the level of liver function after the third RAI therapy,TP(76.77±4.16 versus 73.94±10.08 g/L,P<0.01)and GLO(29.73±3.80 versus 28.71±4.37 g/L,P<0.01)reduced significantly,while DBIL(2.70±1.56 versus 3.22±1.67 umol/L,p<0.05)was higher than the original level.In gender subgroups,TP(76.31±3.91 versus 70.50±16.98 g/L,P<0.05)declined significantly in male subgroup,and GLO(30.17±3.59 versus 28.19±3.32 g/L,P<0.01)declined significantly in female subgroup,but DBIL(2.47±1.02 versus 2.90±1.19 umol/L,p<0.05)increased significantly in female subgroup.As to the level of liver function after the fourth RAI therapy,TBIL(7.90±3.22 versus 9.27±3.07 umol/L,p<0.05)and DBIL(2.26±0.95 versus 3.14±1.13 umol/L,p<0.01)increased significantly.In gender subgroups,TBIL(7.12±2.74 versus 8.71±2.69 umol/L,p<0.05)and DBIL(2.09 ± 0.92 versus 2.91 ± 1.14 umol/L,p<0.05)showed an increasing trend in female subgroup only.Conclusions: Liver function of DTC patients after the first RAI ablation declined significantly,including TP,ALB,GLO,ALT,ALP and GGT.However,after multiple and regular RAI therapies,TBIL and DBIL showed an increasing trend.In gender subgroups,TBIL and DBIL showed an increasing trend in female subgroup only.