Rosário Pedro W S, Barroso Alvaro L, Rezende Leonardo L, Padrão Eduardo L, Borges Michelle A R, Guimarães Valéria C, Purisch Saulo
Department of Thyroid, Endocrinology Service, Santa Casa Belo Horizonte, Minas Gerais, Brazil.
Thyroid. 2006 Jul;16(7):667-70. doi: 10.1089/thy.2006.16.667.
Our aim was to assess testicular function in patients treated with high-dose radioiodine. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were determined in 52 men with thyroid carcinoma before and 6, 12, and 18 months after radioiodine therapy (3.7-5.5 GBq (131)I; mean, 4.25 GBq (131)I) (group 1) and were also determined before and 18 months after the last radioiodine therapy in 22 patients who received high cumulative activities (13-27.7 GBq; mean, 20.3 GBq (131)I) (group 2). FSH levels were increased 6 months after therapy in all patients of group 1, while a decline was observed after 12 months, with 37 of 52 (71%) subjects presenting normal values. FSH values returned to normal after 18 months in all patients. In group 2, 12 of 22 (54.5%) patients presented elevated FSH and 8 (66%) of these individuals had oligospermia. Six months after radioiodine, increased LH levels were observed in only 5 of 52 (9.6%) patients of group 1, which returned to normal after 12 months, and in 5 of 22 (22%) of group 2. All patients showed normal testosterone levels. We conclude that 131I therapy may cause impairment of testicular function. A generally transient increase in FSH is highly common but is usually reversed within 18 months. Oligospermia was common (one third) after high cumulative (131)I activities. Becausee we did not perform a spermiogram before therapy, we cannot state that high cumulative (131)I activities cause permanent infertility. We recommend the routine use of sperm banks in the cases of men who still wish to have children and who will undergo therapy with (131)I activities of 14 GBq or more or in the case of patients with pelvic metastases.
我们的目的是评估接受高剂量放射性碘治疗患者的睾丸功能。在52例甲状腺癌男性患者中，于放射性碘治疗（3.7 - 5.5 GBq ¹³¹I；平均4.25 GBq ¹³¹I）前以及治疗后6、12和18个月测定了促黄体生成素（LH）、促卵泡生成素（FSH）和睾酮水平（第1组）；同时也在22例接受高累积活度（13 - 27.7 GBq；平均20.3 GBq ¹³¹I）治疗的患者中，于最后一次放射性碘治疗前和治疗后18个月进行了测定（第2组）。第1组所有患者在治疗后6个月FSH水平升高，而12个月后出现下降，52例中有37例（71%）受试者FSH值恢复正常。所有患者在18个月后FSH值均恢复正常。在第2组中，22例患者中有12例（54.5%）FSH升高，其中8例（66%）存在少精子症。放射性碘治疗6个月后，第1组52例患者中仅5例（9.6%）LH水平升高，12个月后恢复正常，第2组22例中有5例（22%）升高。所有患者睾酮水平均正常。我们得出结论，¹³¹I治疗可能导致睾丸功能受损。FSH普遍出现短暂升高，但通常在18个月内恢复正常。高累积¹³¹I活度后少精子症很常见（三分之一）。由于我们在治疗前未进行精子分析，所以不能确定高累积¹³¹I活度会导致永久性不育。对于仍希望生育且将接受14 GBq或更高¹³¹I活度治疗的男性患者或盆腔转移患者，我们建议常规使用精子库。
