Thyroid Cancer Treatment: Managing Side Effects and Health Concerns

Thyroid cancer

My mother is 55 years old and has been monitored for nodules for several years.
She was recently informed of malignant changes and was subsequently diagnosed with thyroid cancer at a larger hospital.
Initially, when it was uncertain whether the cancer was malignant, only one side of her thyroid was removed.
After further testing confirmed malignancy, the other side was also removed.
She is currently undergoing regular radioactive iodine (I-131) treatment, having completed two sessions so far.

During her routine check-ups, her triglyceride levels were consistently high, but this time they have decreased.
However, the latest blood test results showed significantly elevated liver enzymes, which are well above the normal range, as well as high low-density lipoprotein (LDL) cholesterol levels.
I would like to know if this is normal or if there are aspects that need adjustment or improvement.
She has been diligent about managing her diet and exercise.
Could this be related to her diet, or are these side effects expected from iodine treatment? The first treatment went well, so why are there issues after the second one?

Yin, 20~29 year old female. Ask Date: 2024/03/20

Dr. Li Jian reply Internal Medicine

Thyroid dysfunction can also lead to abnormal cholesterol levels, and diet has a significant impact as well.
Thank you for your inquiry.

Reply Date: 2024/03/20

More Info

Thyroid cancer treatment, particularly after surgery and radioactive iodine (RAI) therapy, can lead to various side effects and health concerns that need careful management. Your mother's situation, where she has undergone surgery for thyroid cancer and is currently receiving RAI treatment, is not uncommon. However, the emergence of elevated liver enzymes and low-density lipoprotein (LDL) cholesterol levels after her second RAI treatment raises some important considerations.

Firstly, it is essential to understand that RAI therapy is commonly used in the treatment of thyroid cancer, especially for patients who have undergone thyroidectomy. The therapy aims to destroy any remaining thyroid tissue or cancer cells by using radioactive iodine, which is absorbed by thyroid cells. While RAI is generally well-tolerated, it can have side effects, including changes in metabolic processes, which may indirectly affect liver function and lipid profiles.

Elevated liver enzymes can indicate liver stress or damage, which may arise from various factors, including medication side effects, dietary habits, or underlying health conditions. In the context of thyroid cancer treatment, it is crucial to consider the following:
1. Medication Side Effects: If your mother is on any medications, including those for managing thyroid hormone levels or other health issues, these could potentially affect liver function. Certain medications can lead to elevated liver enzymes, and it would be prudent to review her medication list with her healthcare provider.

2. Diet and Lifestyle: While you mentioned that your mother is managing her diet and exercise, it is essential to ensure that her diet is balanced and not overly high in fats, sugars, or processed foods, which can contribute to elevated cholesterol and liver issues. A diet rich in fruits, vegetables, whole grains, and lean proteins is generally recommended. Additionally, regular physical activity can help manage cholesterol levels and support overall health.

3. Thyroid Hormone Levels: After thyroidectomy and RAI, patients often require thyroid hormone replacement therapy. If the dosage is not adequately adjusted, it can lead to fluctuations in metabolism, which may impact liver function and lipid levels. Regular monitoring of thyroid hormone levels is crucial to ensure they remain within the target range.

4. RAI Treatment Effects: While the first RAI treatment may not have resulted in noticeable side effects, individual responses can vary significantly. Factors such as the dose of RAI, the timing of treatment, and the patient's overall health can influence how the body reacts to subsequent treatments. It is not uncommon for patients to experience different side effects with each treatment.

5. Follow-Up and Monitoring: Given the recent changes in liver enzymes and cholesterol levels, it is essential for your mother to have close follow-up appointments with her healthcare provider. They may recommend additional tests, such as imaging studies or further blood tests, to assess liver function and rule out any other underlying issues.

In summary, while some fluctuations in liver enzymes and cholesterol levels can occur after RAI treatment, it is crucial to investigate these changes further. Engaging in open communication with her healthcare team will help address any concerns and ensure that her treatment plan is appropriately adjusted. Regular monitoring and a holistic approach to her health, including diet, exercise, and medication management, will be vital in navigating her recovery and maintaining her overall well-being.

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