Hyponatremia and Cerebral Edema Associated with Radioiodine Therapy for Papillary Thyroid Carcinoma
Abstract
Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.Downloads
References
PGH Working Group on Thyroid Cancer. Clinical Practice Guidelines of the Philippine General Hospital for the management of thyroid nodules and well-differentiated thyroid carcinoma. Acta Medica Philippina. 2008;42(1):56-67.
Mazzaferri EL, Kloos RT. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86:1447-63.
Hurley JR, Becker DV. Nuclear Medicine Annual. New York:Raven Press 1983.
Van Nostrand D, Neutze J,Atkins F. Side effects of “rational dose” iodine-131 therapy for metastatic well-differentiated thyroid carcinoma. J Nucl Med 1986;27(10):1519 –27.
Holmquest DL, Lake P. Sudden hemorrhage in metastatic thyroid carcinoma of the brain during treatment with iodine-131. J Nucl Med. 1975;17(4):307-9.
Datz FL. Cerebral edema following iodine-131 therapy for thyroid carcinoma metastatic to brain. J Nucl Med. 1986;27(5):637-40.
Chiu AC, Delpassand ES, Sherman SI. Prognosis and treatment of brain metastases in thyroid carcinoma. J Clin Endocrinol Metab. 1997;9(11):3637-42.
Schlumberger, MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306.
Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: Benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91(8):2892-9.
Maxon HR III, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am. 1990;19:685–718.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.
Krishnamurthy VR, McDougall IR. Severe hyponatremia: A danger of low-iodine diet. Thyroid. 2007;17(9):889-92.
Shakir MK, Krook LS, Schraml FV, Hays JH, Clyde PW. Symptomatic hyponatremia in association with a low-iodine diet and levothyroxine withdrawal prior to I131 in patients with metastatic thyroid carcinoma. Thyroid. 2008;18(7):787-92.
Nozu T, Yoshida Y, Ohira M, Okumura T. Severe hyponatremia in association with I(131) therapy in a patient with metastatic thyroid cancer. Intern Med. 2011;50(19):2169-74.
Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatremia in hospitalized patients: Treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2006;21(1):70–6.
Skowsky MR, Kikuchi TA. The role of vasopressin in the impaired water excretion of myxedema. Am J Med. 1978;64(4):613-21.
Hoorn EJ, Zietse R. Hyponatremia revisited: Translating physiology to practice. Nephron Physiol. 2008;108(3):46-59.
Schrier RW. Body water homeostasis: Clinical disorders of urinary dilution and concentration. J Am Soc Nephrol. 2006;17(7):1820.
Hanna FW, Scanlon MF. Hyponatremia, hypothyroidism, and role of arginine-vasopressin. Lancet. 1997;350(9080):755.
Kilpatrick, ES. Disorders of sodium balance: Hypothyroidism and hyponatremia: an old wives' tale? BMJ. 2006;332(7545):854.
Croal BL, Blake AM, Johnston J, Glen AC, O'Reilly DS. Absence of relation between hyponatremia and hypothyroidism. Lancet. 1997;350(9088):1402.
Baajafer FS, Hammami MM, Mohamed GED. Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest. 1999;22(1):35–9.
Warner MH, Holding S, Kilpatrick ES. The effect of newly diagnosed hypothyroidism on serum sodium concentrations: A retrospective study. Clin Endocrinol (Oxf). 2006;64(5):598-9.
Maxon HR, Thomas SR, Boehringer A, et al. Low iodine diet in I-131 ablation of thyroid remnants. Clin Nucl Med. 1983;8(3):123–6.
Philippine Senate. Republic Act 8172 - An act promoting salt iodization nationwide and for related purposes. Manila:The Senate;1995.
Thaler SM, Teitelbaum I, Berl T. "Beer potomania" in non-beer drinkers: Effect of low dietary solute intake. Am J of Kidney Dis. 1998;31(6):1028-31.
The American Thyroid Association Taskforce on Radioiodine Safety. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131-I: Practice recommendations of the American Thyroid Association. Thyroid. 2011;21(4):335.
Musch W, Xhaet O, Decaux G. Solute loss plays a major role in polydipsia-related hyponatremia of both water drinkers and beer drinkers. QJM. 2003;96(6):421–6.
Gillum DM, Linas SL. Water intoxication in a psychotic patient with normal renal water excretion. Am J Med. 1984;77(4):773-4.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
