TY - JOUR
T1 - Long-Term Effects of Radioiodine Treatment on Female Fertility in Survivors of Childhood Differentiated Thyroid Carcinoma
AU - Nies, Marloes
AU - Cantineau, Astrid E P
AU - Arts, Eus G J M
AU - van den Berg, Marleen H
AU - van Leeuwen, Flora E
AU - Muller Kobold, Anneke C
AU - Klein Hesselink, Mariëlle Sanne
AU - Burgerhof, Johannes G M
AU - Brouwers, Adrienne H
AU - van Dam, Eveline W C M
AU - Havekes, Bas
AU - van den Heuvel-Eibrink, Marry M
AU - Corssmit, Eleonora P M
AU - Kremer, Leontien C M
AU - Netea-Maier, Romana
AU - van der Pal, Heleen J H
AU - Peeters, Robin P
AU - Plukker, John Th M
AU - Ronckers, Cecile M
AU - van Santen, Hanneke M
AU - van der Horst-Schrivers, Anouk N A
AU - Tissing, Wim J E
AU - Bocca, Gianni
AU - van Dulmen-den Broeder, Eline
AU - Links, Thera P
PY - 2020/8
Y1 - 2020/8
N2 - 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 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 (rs = 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.
AB - 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 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 (rs = 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.
KW - differentiated thyroid carcinoma
KW - childhood cancer
KW - adverse effects
KW - fertility
KW - radioiodine
KW - ANTI-MULLERIAN HORMONE
KW - RADIOACTIVE IODINE ABLATION
KW - OVARIAN RESERVE
KW - I-131 THERAPY
KW - ANTIMULLERIAN HORMONE
KW - CANCER
KW - PREGNANCY
KW - CHILDREN
KW - WOMEN
KW - AMH
U2 - 10.1089/thy.2019.0560
DO - 10.1089/thy.2019.0560
M3 - Article
C2 - 32079487
SN - 1050-7256
VL - 30
SP - 1169
EP - 1176
JO - Thyroid
JF - Thyroid
IS - 8
ER -