Post-Thyroid Cancer Surgery: Fertility Plans and Considerations

Q: Post-Thyroid Cancer Surgery: Fertility Plans and Considerations

Dear Ms. H： 1. The half-life of iodine-131 is approximately 8 days. You may want to consult your attending physician regarding the dosage at that time to estimate the current residual amount in your body. Logically, from November 2015 to the present, it should

Post-thyroid cancer surgery considerations for fertility planning?

Dear Dr.
Hsiao,
I underwent thyroid cancer surgery in early October 2015, which involved a total thyroidectomy and partial lymphadenectomy.
I received radioactive iodine (I-131) treatment in early November 2015, and I started taking Eltroxin 100 mcg around mid-December 2015.
Currently, I have blood tests and follow-up appointments every three months.
During my last appointment in June 2016, my doctor mentioned that my blood test results were normal, with cancer markers nearly at zero.
The doctor still advised waiting a year before planning for pregnancy, so my husband and I are considering starting our family by the end of this year.

I would like to ask Dr.
Hsiao the following questions:
1.
How can I determine if the radiation levels from the I-131 treatment in my body have returned to zero, ensuring it is safe for me to conceive? (I am concerned because my sister-in-law had untreated hyperthyroidism and gave birth to a daughter with dwarfism, which has been confirmed to be due to her genetic factors.
I worry about history repeating itself.)
2.
Since the surgery, my skin has become dry and prone to peeling, particularly around my nose, while the rest of my skin is also dry.
My menstrual cycle initially remained regular but with less flow than before.
However, starting this month, my periods have become irregular.
Could this still be due to endocrine disruption? (I got married at the end of last year, and I wonder if stress might be related.)
Thank you, Dr.
Hsiao.
😊

H, 20~29 year old female. Ask Date: 2016/06/14

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
H:
1.
The half-life of iodine-131 is approximately 8 days.
You may want to consult your attending physician regarding the dosage at that time to estimate the current residual amount in your body.
Logically, from November 2015 to the present, it should theoretically have been depleted by now.
To accurately determine the actual radiation levels, including beta and gamma radiation, it would be advisable to consult a radiation oncologist.
2.
Eltroxin Tablets (100 mcg) are primarily used to supplement thyroid hormone, specifically for the treatment of hypothyroidism.
The clinical manifestations of long-term hypothyroidism include dry, flaky skin, sparse hair, and eyelid edema.
There may be a thickening of the skin due to the accumulation of a mucin-like substance, which does not indent when pressed with a finger.
Mucin accumulation can also occur in the myocardial interstitium and pericardium, sometimes referred to as myxedema heart or hypothyroid cardiomyopathy.
Due to myxedema, there can be enlargement and thickening of the tongue and lips, leading to slurred speech and a deep, hoarse voice.
Anemia and irregular menstrual cycles may also occur.
Endocrine abnormalities, psychological stress, or other issues could contribute to these conditions.
Therefore, it is essential to have a thorough discussion with your attending physician.
3.
Honestly, I strongly recommend that you have a comprehensive discussion with your attending physician regarding your concerns.
The treatment of thyroid cancer often requires consideration of the specific type of thyroid cancer, the degree of cellular differentiation, the stage of the cancer, the treatment methods to be employed, how to manage complications and sequelae, and the prognosis.
Additionally, there may be important considerations regarding pregnancy and childbirth.
This is a specialized field within metabolic science that is not typically discussed by physicians from other specialties.

Reply Date: 2016/06/14

More Info

After undergoing thyroid cancer surgery, it is understandable to have concerns about fertility and overall health. Your situation involves several important factors that need to be addressed, particularly regarding the safety of conceiving after treatment and the physical changes you are experiencing.

1. Radiation Levels Post-I-131 Treatment: I-131 (iodine-131) is a radioactive isotope used in the treatment of thyroid cancer. Its half-life is approximately 8 days, meaning that the amount of radiation in your body decreases significantly over time. By now, given that it has been several months since your treatment, it is likely that the radioactive iodine has been mostly eliminated from your system. However, to ensure that it is safe to conceive, you should consult with your healthcare provider. They may recommend a thyroid function test or a specific scan to measure any residual radioactivity. Additionally, they can provide you with guidelines based on the dose you received and your current health status.

2. Skin Changes and Menstrual Irregularities: The symptoms you are experiencing, such as dry skin and irregular menstrual cycles, can indeed be linked to hormonal imbalances often associated with thyroid dysfunction. After thyroid surgery and I-131 treatment, many patients experience changes in their thyroid hormone levels, which can lead to symptoms of hypothyroidism, including dry skin, hair loss, and menstrual irregularities. The medication you are taking, Eltroxin (levothyroxine), is intended to replace the thyroid hormone your body is no longer producing adequately. It is crucial to have your thyroid hormone levels monitored regularly, as improper dosing can lead to symptoms of either hypothyroidism or hyperthyroidism.

Stress can also play a significant role in hormonal balance. The psychological impact of dealing with cancer and its treatment can contribute to stress-related hormonal changes, which may further exacerbate menstrual irregularities. It is essential to discuss these symptoms with your healthcare provider, who may suggest adjustments to your medication or additional support, such as counseling or stress management techniques.

3. Fertility Considerations: Given that your oncologist has advised waiting a year before trying to conceive, it is essential to follow this recommendation. This waiting period allows your body to stabilize after treatment and ensures that any potential risks to a pregnancy are minimized. It is also a good time to optimize your health, including managing your thyroid levels and addressing any other health concerns.

4. Genetic Concerns: Your mention of family history regarding genetic conditions is valid. While your sister-in-law's case of dwarfism was determined to be genetic, it is understandable to have concerns about hereditary issues. Genetic counseling may be beneficial if you have specific worries about passing on conditions. A genetic counselor can provide insights into your family's medical history and help assess any risks.

In summary, it is vital to maintain open communication with your healthcare team regarding your fertility plans and any physical changes you are experiencing. Regular monitoring of your thyroid function, addressing skin and menstrual issues, and considering genetic counseling are all proactive steps you can take. Your health and well-being are paramount as you plan for the future, and ensuring that you are in the best possible condition before conception is essential.

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