ABSTRACT
Acute complications after bariatric surgery include rhabdomyolysis and immobilization hypercalcemia. The most common long-term metabolic complications following bariatric surgery are anemia and metabolic bone disease. Neuropathy, acute Wemicke's encephalopathy and vitamin A deficiency also occur. Prevention, diagnosis,and treatment of these disorders are necessary parts of lifelong care after bariatric surgery.
Subject(s)
Digestive System Surgical Procedures/adverse effects , Metabolic Diseases/diagnosis , Metabolic Diseases/therapy , Obesity, Morbid/surgery , Stomach/surgery , Adult , Biliopancreatic Diversion/adverse effects , Biliopancreatic Diversion/methods , Body Mass Index , Digestive System Surgical Procedures/methods , Female , Follow-Up Studies , Gastric Bypass/adverse effects , Gastric Bypass/methods , Gastroplasty/adverse effects , Gastroplasty/methods , Humans , Jejunoileal Bypass/adverse effects , Jejunoileal Bypass/methods , Male , Metabolic Diseases/etiology , Middle Aged , Obesity, Morbid/diagnosis , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Risk Assessment , Severity of Illness IndexABSTRACT
INTRODUCTION: Patients with well-differentiated thyroid cancer have a good prognosis but a significant chance for local recurrence. In the past, limited surgery with postoperative 131I only for extremely high-risk cases or recurrence was not uncommon. As more aggressive surgical and postoperative treatments appear to gain wider acceptance, toxicity and long-term morbidity become more important issues. Our goal is to present the experience of a single institution with emphasis on oral side effects related to 131I as well as acute and chronic symptoms related to this diagnosis and their impact on quality of life. METHODS: Fifty-seven patients were followed for a median time of 19.3 months. All patients received therapeutic 131I (mean dose, 154.7 mCi) between January 1, 1996 and August 30, 2002. RESULTS: Fifty-four patients (94.7%) were alive at the time of analysis. Sixteen (28.1%) required a second treatment: any sign of persistence resulted in retreatment. Complaints with 131I treatment included altered taste, 26.3%; acute xerostomia, 21.1%; and acute sialoadenitis, 15.8%. Chronic xerostomia occurred in 6 (35.3%) of all patients who received multiple treatments. The incidence of chronic xerostomia was reduced to 1 of 11 (9.1%) with amifostine pretreatment. Other chronic side effects associated with this disease included fatigue 54.4%, weight gain of more than 6 months duration 24.6%, with 12 (27.9%) of those under 60 experiencing an average gain of 2.3 kg from initial diagnosis. CONCLUSION: Review of treatment-related symptoms prompted policies to reduce toxicity including amifostine pretreatment for 131I therapy and thyrotropin (synthetic TSH) use in place of iatrogenic hypothyroidism for thyroglobulin testing and scanning.
Subject(s)
Iodine Radioisotopes/therapeutic use , Quality of Life , Thyroid Neoplasms/physiopathology , Thyroid Neoplasms/radiotherapy , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Amifostine/therapeutic use , Chronic Disease , Fatigue/etiology , Female , Humans , Iodine Radioisotopes/adverse effects , Male , Middle Aged , Radiation Injuries/complications , Radiation-Protective Agents/therapeutic use , Retreatment , Sialadenitis/etiology , Taste/radiation effects , Thyroid Neoplasms/mortality , Thyrotropin/therapeutic use , Treatment Outcome , Weight Gain , Xerostomia/etiology , Xerostomia/prevention & controlABSTRACT
A patient with widely metastatic differentiated thyroid cancer who had been heavily pretreated with (131)I was given recombinant human thyroid stimulating hormone (rhTSH) prior to (131)I treatment. Clinical and physical data from both this case and the literature suggest that the recombinant hormone, not the (131)I, may have caused a significant portion of the tumor swelling, which in turn was the most likely cause of the patient's symptoms. The potential effect of (131)I-induced tumor swelling and direct radiation effect on the lung is also analyzed. We review the potential hazards associated with rhTSH in patients with metastasis and propose means of minimizing this risk.
