17
Recommendation 40
A. Patients should be counseled that RAI treatment may be associated
with (acute and chronic) salivary gland morbidity, lacrimal duct
stenosis, and potential risk of secondary malignancies. (GPS)
B. For prevention of salivary gland side effects after RAI, general
measures including hydration are recommended. (GPS)
C. Patients with xerostomia are at increased risk of dental caries
and should discuss preventive strategies with their dental health
professional. (GPS)
D. Surgical correction should be considered for nasolacrimal outflow
obstruction, which often presents with excessive tearing (epiphora)
but also predisposes to infection. (GPS)
Recommendation 41
➤ Patients should be counseled about the risks of second primary
malignancy (SPM) after RAI treatment for DTC. The absolute increase
in risk attributable to RAI appears to be small and does not warrant
additional screening for SPM. (GPS)
Recommendation 42
➤ Patients receiving therapeutic administration of RAI should have
a baseline complete blood count (CBC) and assessment of renal
function. (GPS)
Recommendation 43
A. Female patients of reproductive age receiving RAI therapy should
have a negative screening evaluation for pregnancy prior to RAI
administration and avoid pregnancy for at least six months after
receiving RAI. (GPS)
B. RAI should not be given to nursing female patients. Depending on
the clinical situation, RAI therapy should be deferred until lactating
women have stopped breast-feeding or pumping for at least three
months. A diagnostic
123
I scan may be performed in recently
lactating women to detect breast uptake that may warrant deferral of
therapy. (GPS)
C. Male patients receiving cumulative radioiodine activities >14.8
gigabecquerels (GBq) (400 millicuries [mCi]) should be counseled
regarding potential risks of infertility. (GPS)
D. Female patients receiving RAI should be counseled that such therapy
has not been shown to impact future fertility. (GPS)
