Management of iodine-131 ablation therapy for thyroid carcinoma in a patient on chronic hemodialysis

• Published in: Néphrologie & thérapeutique Vol. 11; no. 2; pp. 114 - 117
• Main Authors: Zenasni, Nadia, Elkhayat, Salma, Taleb, Sara, Zamd, Mohammed, Medkouri, Ghizlaine, Benghanem Gharbi, Mohammed, Ramdani, Benyounes, Aschawa, Hind, Guensi, Amal
• Format: Journal Article
• Language: French
• Published: France 01.04.2015
• Subjects: Adult; Carcinoma - radiotherapy; Carcinoma, Papillary; Humans; Iodine Radioisotopes - therapeutic use; Kidney Failure, Chronic - therapy; Male; Peritoneal Dialysis, Continuous Ambulatory; Radiotherapy Dosage; Thyroid Cancer, Papillary; Thyroid Neoplasms - radiotherapy; Carcinome papillaire de la thyroïde; Dialyse péritonéale continue ambulatoire; Radiation safety; Hemodialysis; I; Hémodialysé; Radioprotection; Iodine-131; Papillary thyroid carcinoma; Continuous ambulatory peritoneal dialysis therapy
• ISSN: 1872-9177
• DOI: 10.1016/j.nephro.2014.11.007

Iodine-131 ablation therapy for thyroid cancer in the patient on chronic hemodialysis represents a real problem since the main route of elimination of radioiodine is urinary. There is no recommendation on the management of this treatment in the patient on hemodialysis. We report our experience of management of this treatment in a patient aged 38 years, undergoing hemodialysis for chronic renal failure, and who have been indicated the treatment with iodine-131 for papillary thyroid carcinoma high risk. After multidisciplinary discussions (nephrologists and specialists in nuclear medicine and radiation safety), it has been decided to treat the patient with continuous ambulatory peritoneal dialysis therapy (CAPD). Because of the low but continuous elimination of iodine in the case of CAPD, the patient received a reduced ablative (131)I dose of 1850 MBq, which is 30% of the usual dose delivered in subjects with normal renal function. The patient was hospitalized for four days in nuclear medicine unit and the (131)I radioactivity emitted from him was 2.5 μSv/h at one meter at his hospital discharge. In conclusion, CAPD in relay of hemodialysis is a technique of renal replacement therapy that can be suggested to minimize exposure to radioactivity to the patient, his family and the medical staff.