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Epiphora After Radioactive Iodine Therapy in a Low-Risk Patient Heesung Song, MD,* Jinho Jeong, MD,† and Myeong Ju Koh, MD‡ Abstract: It has been demonstrated that radioactive iodine therapy (RIT) is very useful for ablating remnant thyroid tissue or metastatic lesions after total thyroidectomy in well-differentiated thyroid cancer. Epiphora as a result of lacrimal drainage system obstruction is a rare complication of RIT. Previous studies have shown that most patients with epiphora after RIT are old ages, females, and with high cumulative radioactive iodine dose. Here, we report on a case of epiphora with low-risk factors including young ages, male, and 5.5-GBq (150-mCi) dose in the first RIT. Key Words: epiphora, radioactive iodine therapy, thyroid cancer (Clin Nucl Med 2015;40: 536–537)

Received for publication September 16, 2014; revision accepted December 10, 2014. From the Departments of *Nuclear Medicine, †Ophthalmology, and ‡Radiology, Jeju National University School of Medicine, Jeju, Republic of Korea. Conflict of interest and sources of funding: none declared. Reprints: Heesung Song, MD, Department of Nuclear Medicine, Jeju National University School of Medicine, Aran 13gil 15 (Ara-dong), Jeju city, Jeju, Republic of Korea. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4006–0536

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REFERENCES 1. Morgenstem KE, Vadysirisack DD, Zhang Z, et al. Expression of sodium iodide symporter in the lacrimal drainage system: implication for the mechanism underlying nasolacrimal duct obstruction in I(131)-treated patients. Ophthal Plast Reconstr Surg. 2005;21:337–344. 2. Kloos RT, Duvuuri V, Jhiang SM, et al. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. 2002;87:5817–5820. 3. Oh JR, Ahn BC: False-positive uptake on radioiodine whole-body scintigraphy: physiologic and pathologic variants unrelated to thyroid cancer. Am J Nucl Med Mol Imaging. 2012;2:362–385. 4. Yuoness S, Rachinsky I, Driedger AA, et al. Differentiated thyroid cancer with epiphora: detection of nasolacrimal duct obstruction on I-131 SPECT/CT. Clin Nucl Med. 2011;36:1149–1152. 5. Brockmann H, Wilhelm K, Joe A, et al. Nasolacrimal drainage obstruction after radioiodine therapy: case report and a review of the literature. Clin Nucl Med. 2005;30:543–545. 6. Shepler TR, Sherman SI, Faustina MM, et al. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthal Plast Reconstr Surg. 2003;19:479–481. 7. Sakahara H, Yamashita S, Suzuki K, et al. Visualization of nasolacrimal drainage system after radioiodine therapy in patients with thyroid cancer. Ann Nucl Med. 2007;21:525–527. 8. Burns JA, Morgenstern KE, Cahill KV, et al. Nasolacrimal obstruction secondary to I(131) therapy. Ophthal Plast Reconstr Surg. 2004;20:126–129.

Clinical Nuclear Medicine • Volume 40, Number 6, June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Clinical Nuclear Medicine • Volume 40, Number 6, June 2015

Epiphora After Radioactive Iodine Therapy

FIGURE 1. A 28-year-old man underwent total thyroidectomy owing to papillary thyroid cancer. Radioactive iodine therapy (RIT) with 5.5 GBq (150 mCi) was performed after 4 months. During hospitalization, the patient had no complaints of symptoms, suggesting an acute complication due to RIT. Six months after discharge, he complained of a swelling on right parotid gland area and epiphora of right eye. Scintigraphy with 131I taken on the second day after RIT of 5.5 GBq (150 mCi) was reviewed retrospectively. The images demonstrated focal 131I uptake with asymmetric pattern in the medial side of right orbit region (white arrows; A, anterior view; B, posterior view; C–D, lateral view). Dacryocystography was carried out as a further evaluation. The study revealed that the left lacrimal drainage system had no significant obstruction (E, anterior view; F, lateral view). However, the right inferior canaliculus was occlusive (white arrows; G, anterior view; H, lateral view). It was suspected that the occlusion of right inferior canaliculus caused epiphora of the right eye. Surgical procedures were recommended. However, the patient refused additional treatment. Because the mucosal area of lacrimal ducts has Na-I symporter, RIT may cause an obstruction of lacrimal drainage system resulting in epiphora.1–3 Previous researches showed that most patients with epiphora after RIT were old ages, females, and with high cumulative radioactive iodine dose.4–8

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Epiphora after radioactive iodine therapy in a low-risk patient.

It has been demonstrated that radioactive iodine therapy (RIT) is very useful for ablating remnant thyroid tissue or metastatic lesions after total th...
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