Update on lacrimal apparatus dysfunction associated with differentiated thyroid cancer after I-131 therapy

Area of Science:

• Ophthalmology
• Endocrinology
• Oncology

Background:

• Differentiated thyroid cancer (DTC) treatment often involves radioactive iodine (I-131) therapy.
• I-131 therapy can lead to significant lacrimal apparatus dysfunctions, including dry eye and nasolacrimal duct obstruction (NLDO).
• These conditions negatively impact patients' quality of life and require effective management strategies.

Purpose of the Study:

• To comprehensively review and analyze the current understanding of mechanisms behind I-131-induced lacrimal apparatus dysfunction in DTC patients.
• To summarize and evaluate existing and emerging therapeutic options for these ocular complications.

Main Methods:

• A systematic literature search was conducted across CNKI, PubMed, and Web of Science databases up to December 2023.
• Keywords included "Thyroid cancer", "I-131", "Complications", "Dry eye", "Epiphora", "Tear", "Nasolacrimal duct", and "NLDO".

Main Results:

• I-131 therapy damages lacrimal glands and the nasolacrimal duct system, causing dry eye, epiphora, and secretions.
• Research is exploring risk factors and treatments, but mechanisms remain debated.
• Potential mechanisms include passive I-131 flow, active uptake via sodium-iodide symporter (NIS), or secondary hormonal changes.

Conclusions:

• Early detection and preventive measures by ophthalmologists are essential for managing I-131-related lacrimal dysfunction.
• Further research is critically needed to fully elucidate the underlying mechanisms of these complications.