A Study Of The Effect Of ¹³¹I Therapy On Ovarian Function In Female Patients With Differentiated Thyroid Carcinoma Of Childbearing Age

ObjectiveTo explore the effect of ¹³¹I therapy on ovarian function in female patients with differentiated thyroid carcinoma（DTC）of childbearing age.MethodsSeventy-one women of childbearing age were chosed who are postoperative patients with thyroid cancer that were treated with ¹³¹I from in June 2013 to February2017 at Nuclear Medicine Department of Fujian Provincial Hospital.The average age of these women was 35.7±6.13（range,22-44）years,and they had been treated with¹³¹I for 1 5 times.Among them,40 patients had been treated with ¹³¹I for 1 time,27 patients had been treated with ¹³¹I for 2 times.1 patient had been treated with ¹³¹I for 3times,2 patients had been treated with ¹³¹I for 4 times,and 1 patient had been treated with ¹³¹I for 5 times.The cumulative dose of ¹³¹I was 3.7 37GBq（100 1000 m Ci）,（median 3.7 GBq）.Among them,the cumulative dose of ¹³¹I for 40 patients was 3.7GBq,the cumulative dose of ¹³¹I for 22 patients was 7.4GBq,and 9.25 GBq for4 patients,5.55 GBq for 1 patient,14.8GBq for 1 patient,27.75 GBq for 1 patient,28.67 GBq for 1 patient and 37 GBq for 1 patient.Details of menstrual cycle were noted before and after the treatment of ¹³¹I.Measurements of follicle stimulating hormone（FSH）,luteinising hormone（LH）,and oestradiol（E2）were undertaken after¹³¹I therapy.The study used SPSS 22.0 to process data,including T-test and chi-square test,and when P < 0.05,the difference was statistically significant.Results1.Overall,34 of 71 women（47.9%）had menstrual irregularities after treatment which is mainly manifested on amenorrhea,oligomenorrhea and the extension ofmenstrual cycle.Three patients had unnormal menstrual cycles before therapy and two of them had pretreatment menstrual cycle irregularities that persisted or were exaggerated after therapy.The patients’ menstrual cycle and menses irregularities were significantly increased after ¹³¹I therapy（χ2=32.896,P=0.00）compared with themselves before ¹³¹I therapy and seemed to increase with age.The average age of patients who had menstrual irregularities and oligomenorrhea wre significantly higher than that of the women who had no menstrual irregularities（37.41±5.389 vs.34.14±6.417 years,P=0.023;37.25±4.29 vs.34.14±6.417years;P=0.033）.The patients who had amenorrhea（average age of 41.80±1.095 years）were older than women who had no menstrual irregularities or oligomenorrhea（average age of37.25±4.29 years）.The age of patients who had extension of menstrual cycle was similar to the women who had no menstrual irregularities（P>0.05）.There was no significantly difference in the number of treatments（1 and ≥2）,and the dose of the last treatment（3.7GBq and ≥5.55GBq）between women who experienced menstrual irregularities and did not after ¹³¹I therapy.There was no significantly difference in the median cumulative dose of ¹³¹I for patients who had menstrual irregularities and had no menstrual irregularities（7.4GBq vs 3.7GBq）（Z=-1.65,P=0.099）.2.Patients with higher serum levels of FSH than the normal value were more likely to have oligomenorrhea（χ2=8.12,P=0.004）,and there were no significant difference in the incidence of oligomenorrhea between women whose serum levels of FSH was lower and in the normal value（P > 0.05）.There was no significant correlation between the changes of serum levels of E2,LH and the incidence of oligomenorrhea.3.Patients with lower serum levels of AMH below the normal range were more likely to have menstrual irregularities after treatment（χ2=7.567,P=0.006）.In a period of 5 to 20 weeks after treatment,the serum levels of AMH were significantly lower than that before treatment（P < 0.05）.And the serum levels of AMH were minimized in the period of 5 to 9 weeks after treatment.After 20 weeks of treatment,the serum levels of AMH in patients were still lower than that before treatment,but the results did not reach statistical significance（P > 0.05）.Conclusions1.¹³¹I therapy of DTC may lead to a transient failure in ovarian function in women of childbearing age,and the damaging can be repaired by itself.2.There are not a significant relationship between the risk of ovarian dysfunction after ¹³¹I therapy of DTC and the cumulative dose of ¹³¹I,or ¹³¹I dose of latest one treatment（3.7GBq,5.55GBq）,if the dose of ¹³¹I is 3.7 9.25GBq（100 250 m Ci）in a single ¹³¹I therapy.3.The application of AMH in the evaluation of ovarian reserve is of great value in clinical application.Compared with FSH,LH and E2,AMH can be used to evaluate the ovarian function more accurately and early.4.There should be a further studied of the relationship between the risk of ovarian dysfunction after ¹³¹I therapy of DTC and the number of ¹³¹I treatment.