EVALUATION OF THYROID DYSFUNCTIONS AFTERTRANSARTERIAL CHEMOEMBOLIZATION FOR HCV-RELATED HEPATOCELLULAR CARCINOMA
Hany Sayed Abd-El Monem;
Abstract
Summary
T
he diagnosis of HCC was almostalways made when the disease was advanced, whenpatients were symptomatic and presented with a variabledegree of liver function impairment,At this latestage virtually no treatment had any chance of beingeffective or of significantly improving survival.
That’s why Transarterial chemoembolization (TACE) was introduced as a palliative treatment in patients with un-resectable HCC, it has become one of the most common forms of interventional therapy.
Procedure involvesselective catheterization of the hepatic segmental arteries nourishing the HCC lesions and the application of iodide in the form of iodized oil as a radio-opaque contrast medium(lipiodol), mixed with a chemotherapeutic agent induces ischemic tumor necrosis while minimizing damage to theliver tissue.
The use of TACE to treat HCC began after Lipiodol was introduced as Chemotherapeutic agents carrier and an embolic agent.
Lipiodol is better than other embolic agents in that it's not only has an embolic effects onsmaller vessels, but also selectivelyremains more in tumor nodules for several weeks to over ayear, and theanticancer drug is slowly released from Lipiodol andremains in high concentrations within the tumor for a prolonged period,and that expands the exposure of the neoplastic cells to chemotherapy.
Lipiodol and related compounds are products of the addition of iodine to double bonds of the unsaturated fatty acids.
The volume of (10ml-15ml) needed in the procedure of TACErepresents a significant iodine load, a single dose contains 13,500 μgof free iodide, as well as 15-60 g of boundiodine that may be liberated to free iodide followingadministration which is 90-to-several-hundred-thousand-foldthe daily recommended intake for adults (150mcg).
Although required for thyroid hormone synthesis, excessintra-thyroid iodidecan disrupt thyroid hormoneregulation, resulting inacute or chronic thyroiditis, hypothyroidism, or hyperthyroidism which could be clinically or sub clinically, transient or permenant.
The aim of our study was the evaluation of the thyroid dysfunctions after TACE procedure using lipiodol for patients with HCV related hepatocellular carcinoma.
This study was conducted to group of 30 patients with proved diagnosis ofHCV related HCC and subjected to TACE.
All patients were subjected to full history taking, clinical examination with special stress on thyroid disorders manifestations, and laboratory investigations included complete blood count, liver profile, serum AFP, renal profile.
Thyroid profile: free T3, free T4 and TSH was measured before TACE and one week, one month after TACE with re-history taking and clinical examination for manifestation of thyroid dysfunction.
In our study we found that using lipiodol in TACE procedure act as iodine lode and might cause thyroid dysfunction by hypothyroidism or hyperthyroidism.
The effect of TACE on our subjected patient was sub-clinically thyroid dysfunction, with no symptoms or signs found.
It was noticed that changes in some thyroid hormones after exposure to TACE could be in significant relation to ALT levels.
There was no significant relation between age, sex, child-class, residence and the changes found in thyroid hormones.
T
he diagnosis of HCC was almostalways made when the disease was advanced, whenpatients were symptomatic and presented with a variabledegree of liver function impairment,At this latestage virtually no treatment had any chance of beingeffective or of significantly improving survival.
That’s why Transarterial chemoembolization (TACE) was introduced as a palliative treatment in patients with un-resectable HCC, it has become one of the most common forms of interventional therapy.
Procedure involvesselective catheterization of the hepatic segmental arteries nourishing the HCC lesions and the application of iodide in the form of iodized oil as a radio-opaque contrast medium(lipiodol), mixed with a chemotherapeutic agent induces ischemic tumor necrosis while minimizing damage to theliver tissue.
The use of TACE to treat HCC began after Lipiodol was introduced as Chemotherapeutic agents carrier and an embolic agent.
Lipiodol is better than other embolic agents in that it's not only has an embolic effects onsmaller vessels, but also selectivelyremains more in tumor nodules for several weeks to over ayear, and theanticancer drug is slowly released from Lipiodol andremains in high concentrations within the tumor for a prolonged period,and that expands the exposure of the neoplastic cells to chemotherapy.
Lipiodol and related compounds are products of the addition of iodine to double bonds of the unsaturated fatty acids.
The volume of (10ml-15ml) needed in the procedure of TACErepresents a significant iodine load, a single dose contains 13,500 μgof free iodide, as well as 15-60 g of boundiodine that may be liberated to free iodide followingadministration which is 90-to-several-hundred-thousand-foldthe daily recommended intake for adults (150mcg).
Although required for thyroid hormone synthesis, excessintra-thyroid iodidecan disrupt thyroid hormoneregulation, resulting inacute or chronic thyroiditis, hypothyroidism, or hyperthyroidism which could be clinically or sub clinically, transient or permenant.
The aim of our study was the evaluation of the thyroid dysfunctions after TACE procedure using lipiodol for patients with HCV related hepatocellular carcinoma.
This study was conducted to group of 30 patients with proved diagnosis ofHCV related HCC and subjected to TACE.
All patients were subjected to full history taking, clinical examination with special stress on thyroid disorders manifestations, and laboratory investigations included complete blood count, liver profile, serum AFP, renal profile.
Thyroid profile: free T3, free T4 and TSH was measured before TACE and one week, one month after TACE with re-history taking and clinical examination for manifestation of thyroid dysfunction.
In our study we found that using lipiodol in TACE procedure act as iodine lode and might cause thyroid dysfunction by hypothyroidism or hyperthyroidism.
The effect of TACE on our subjected patient was sub-clinically thyroid dysfunction, with no symptoms or signs found.
It was noticed that changes in some thyroid hormones after exposure to TACE could be in significant relation to ALT levels.
There was no significant relation between age, sex, child-class, residence and the changes found in thyroid hormones.
Other data
| Title | EVALUATION OF THYROID DYSFUNCTIONS AFTERTRANSARTERIAL CHEMOEMBOLIZATION FOR HCV-RELATED HEPATOCELLULAR CARCINOMA | Other Titles | تقييم الخلل الوظيفى بالغدة الدرقية بعد العلاج الانسدادي الكيميائى بالشرايين الكبديه لسرطان الخلايا الكبدية الناتج عن الالتهــاب الكبدى الوبائـى (سي) | Authors | Hany Sayed Abd-El Monem | Issue Date | 2012 |
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