Lee Irene T, Chen Wencong, Chen Qingxia, Cole Heather A, Bischoff Lindsay A, Jessop Aaron C, Sobel Rachel K
Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Endocr Pract. 2022 Dec;28(12):1210-1215. doi: 10.1016/j.eprac.2022.08.006. Epub 2022 Aug 13.
To identify factors associated with radioactive iodine (RAI)-acquired nasolacrimal duct obstruction (NLDO).
Retrospective chart review and telephone surveys of patients who received RAI therapy for thyroid carcinoma at an academic institution were conducted. Telephone surveys were used to screen for post-RAI NLDO diagnoses. Databases were reviewed for documented NLDO, demographics, RAI dose, total number of RAI treatments, and sialadenitis. Routine post-RAI whole-body scintigraphy (WBS) images were analyzed for the presence or absence of I sodium iodide (I-131) in the nasolacrimal duct. Intranasal I-131 activity was graded as none, low, moderate, and high; those with moderate or high activity were considered to have "increased" activity. Logistic and ordinal logistic regression models were used to evaluate the associations with NLDO while adjusting for I-131 dose.
Of the 209 patients who completed the survey, 15 (7%) had NLDO diagnoses. Increased intranasal I-131 activity on WBS, presence of nasolacrimal I-131 WBS activity, presence of documented post-RAI sialadenitis, and history of >1 RAI treatment were associated with the development of NLDO from univariate analyses (P ≤ .013). After adjusting for the administered dose of I-131, the presence of sialadenitis and nasolacrimal I-131 activity on WBS were the remaining 2 factors significantly associated with NLDO development (P < .001 and P = .01, respectively).
The presence of sialadenitis and nasolacrimal I-131 activity on WBS are I-131 dose-independent correlative factors for RAI-associated NLDO. Patients with these characteristics should be counseled on their increased risk of NLDO after RAI therapy for thyroid carcinoma.
确定与放射性碘（RAI）所致鼻泪管阻塞（NLDO）相关的因素。
对在一所学术机构接受RAI治疗甲状腺癌的患者进行回顾性病历审查和电话调查。电话调查用于筛查RAI后NLDO诊断。查阅数据库以获取记录的NLDO、人口统计学资料、RAI剂量、RAI治疗总数和涎腺炎情况。分析常规RAI后全身闪烁显像（WBS）图像，观察鼻泪管中是否存在碘化钠（I-131）。鼻内I-131活性分为无、低、中、高四级；中度或高度活性者被视为具有“增加”的活性。在调整I-131剂量的同时，使用逻辑回归和有序逻辑回归模型评估与NLDO的相关性。
在完成调查的209例患者中，15例（7%）有NLDO诊断。单因素分析显示，WBS上鼻内I-131活性增加、鼻泪部I-131 WBS活性的存在、记录的RAI后涎腺炎的存在以及>1次RAI治疗史与NLDO的发生相关（P≤0.013）。在调整I-131给药剂量后，涎腺炎的存在和WBS上鼻泪部I-131活性是与NLDO发生显著相关的其余2个因素（分别为P<0.001和P=0.01）。
涎腺炎的存在和WBS上鼻泪部I-131活性是RAI相关NLDO的I-131剂量独立相关因素。对于具有这些特征的患者，应告知其在接受甲状腺癌RAI治疗后发生NLDO的风险增加。
