Sawka Anna M, Lea Jane, Alshehri Bandar, Straus Sharon, Tsang Richard W, Brierley James D, Thabane Lehana, Rotstein Lorne, Gafni Amiram, Ezzat Shereen, Goldstein David P
Division of Endocrinology, Department of Medicine, University Health Network Toronto, Ontario, Canada.
Clin Endocrinol (Oxf). 2008 Apr;68(4):610-7. doi: 10.1111/j.1365-2265.2007.03081.x. Epub 2007 Oct 31.
For patients with well-differentiated thyroid carcinoma (WDTC), the gonadal effects of radioactive iodine (RAI) therapy is an important consideration.
We systematically reviewed the controlled studies examining the gonadal effects of RAI therapy in male WDTC survivors. We searched in nine electronic databases. All abstracts and papers were independently reviewed by two reviewers.
After reviewing 334 abstracts and 59 full-text papers, seven papers were included. In longitudinal studies examining the effect of single primary RAI dose activities of <or= 150 mCi, serum FSH and LH rose between months 2 and 6, with normalization by 18 months; serum testosterone did not significantly decrease. In one study, 18 months after RAI, the rates of elevated serum FSH were: 27% for 351-594 mCi and 81% for > 594 mCi. Cumulative RAI dose correlated with FSH measurements at long-term follow-up. In one study, approximately one in eight men experienced oligospermia 1 year after RAI therapy. Rates of infertility, pregnancy loss and offspring congenital malformation were not elevated, but studies were limited by small size and self-reported outcomes.
Abnormalities in testicular function are common within several months of a single therapeutic dose of RAI for WDTC. Biochemical abnormalities usually resolve within 18 months after administration of a single activity of < 150 mCi of RAI. The risk of persistent gonadal dysfunction is increased after repeated or high cumulative RAI activities. Controlled, prospective studies, with long-term follow-up, examining male gonadal and offspring effects of RAI therapy are needed.
对于高分化甲状腺癌（WDTC）患者，放射性碘（RAI）治疗对性腺的影响是一个重要的考量因素。
我们系统回顾了关于RAI治疗对男性WDTC幸存者性腺影响的对照研究。我们在九个电子数据库中进行了检索。所有摘要和论文均由两名评审员独立评审。
在评审了334篇摘要和59篇全文论文后，纳入了七篇论文。在纵向研究中，当单次主要RAI剂量活度≤150 mCi时，血清促卵泡生成素（FSH）和促黄体生成素（LH）在第2至6个月升高，并在18个月时恢复正常；血清睾酮没有显著下降。在一项研究中，RAI治疗18个月后，血清FSH升高的发生率分别为：351 - 594 mCi组为27%，>594 mCi组为81%。长期随访时，累积RAI剂量与FSH测量值相关。在一项研究中，约八分之一的男性在RAI治疗1年后出现少精子症。不育、流产和后代先天性畸形的发生率没有升高，但研究因样本量小和自我报告的结果而受到限制。
对于WDTC，单次治疗剂量的RAI后数月内睾丸功能异常很常见。当单次给予活度<150 mCi的RAI后，生化异常通常在18个月内恢复。重复或高累积RAI活度后，持续性腺功能障碍的风险增加。需要进行有长期随访的对照前瞻性研究，以检查RAI治疗对男性性腺和后代的影响。
