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¹³¹I Therapy for Differentiated Thyroid Cancer Leads to an Earlier Onset of Menopause: Results of a Retrospective Study

Departments of Endocrinology and Internal Medicine (W.B.), University of Pisa, 56122 Pisa, Italy

Address all correspondence and requests for reprints to: Dr. Claudia Ceccarelli, Dipartimento di Endocrinologia, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56122 Pisa, Italy. E-mail: claudiac{at}endoc.med.unipi.it

Abstract

Treatment with ¹³¹I for differentiated thyroid cancer may give a follicle-damaging radiation dose to the ovaries. This damage to the ovarian function could shorten the fertile life span and advance the natural menopause. To address this issue, we studied retrospectively the menopausal age of 130 women treated with ¹³¹I for differentiated thyroid cancer in our institution from 1974–1993. The menopausal age of women treated with ¹³¹I for differentiated thyroid cancer after total thyroidectomy and subjected to suppressive L-T₄ therapy was compared with the menopausal age of a control group including 127 goitrous women who were treated with suppressive L-T₄ for a comparable period of time. The cumulative therapeutic ¹³¹I dose to cancer patients ranged from 1,110–40,700 MBq (mean ± SD, 5,308 ± 5,483 MBq; median, 3700 MBq). All patients chosen for the study were younger than 45 yr when first treated (i.e. first administration of ¹³¹I and L-T₄ for cancer patients, and institution of L-T₄therapy for goitrous patients), and older than 45 yr at the end of the study period. The menopausal status of both groups was assessed from the clinical records and compared using Kaplan-Meier survival analysis. The menopausal age of cancer women treated with ¹³¹I and suppressive L-T₄ therapy was less than that of goitrous patients treated with suppressive L-T₄ therapy (P < 0.001). We could not detect any relationship between menopausal age and the age at the first or last ¹³¹I dose or to the cumulative ¹³¹I dose received. These data indicate that ¹³¹I treatment is probably associated with an earlier ovarian failure in thyroid cancer patients. Conceivably, the ovarian irradiation by ¹³¹I might contribute to the process of the follicular atresia, thus inducing earlier menopause.

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