problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl9716problendo-9716Research ArticleОбзорыReviewsВторичная облитерация слезоотводящих путей после терапии радиоактивным йодомSecondary acquired nasolacrimal duct obstruction after radioiodine therapyhttps://orcid.org/0000-0003-2990-8111ЯрцевВасилий ДмитриевичYartsevVasily D.

к.м.н.

MD, PhD

v.yartsev@niigb.ruhttps://orcid.org/0000-0001-9875-6217АтьковаЕвгения ЛьвовнаAtkovaEugenia L.

к.м.н.

MD, PhD

evg.atkova@mail.ru<p>ФГБНУ &laquo;НИИ глазных болезней&raquo;</p>Россия<p>Scientific Research Institute of Eye Diseases</p>Russian Federation201801042019646397401Copyright &#x00A9; Ярцев В.Д., Атькова Е.Л., 20182018Ярцев В.Д., Атькова Е.Л.Yartsev V.D., Atkova E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/9716

Вторичная облитерация слезоотводящих путей, возникающая после терапии радиоактивным йодом, относится к числу редких, но требующих коррекции в ранние сроки осложнений. Симптомами вторичной облитерации слезоотводящих путей являются слезотечение, покраснение глаза, появление отделяемого на глазной поверхности, уплотнения в области слезного мешка. Указанное осложнение развивается после терапии радиоактивным йодом в дозе от 150 мКи, частота его развития дозозависима. Клинических рекомендаций по профилактике вторичной облитерации слезоотводящих путей не существует, однако есть сообщения о превентивной интубации слезоотводящих путей и разработке новых лекарственных средств, блокирующих действие белка, осуществляющего захват йода в слизистой оболочке слезоотводящих путей. Для постановки диагноза необходимо специальное исследование, а также консультация офтальмолога. Для коррекции возникшей облитерации применяют консервативное лечение, которое характеризуется низкой эффективностью, а также различные варианты реканализации слезоотводящих путей и наложение различных соустий между полостью носа и слезоотводящими путями. При раннем обращении пациентов возможно проведение более функциональных и малоинвазивных вмешательств, при позднем обращении требуются более обширные хирургические вмешательства.

Secondary acquired nasolacrimal duct obstruction after radioiodine therapy is a comparatively rare complication but it requires treatment at an early stage. The symptoms of secondary acquired nasolacrimal duct obstruction are tearing, eye redness, discharge at ocular surface, a mass growing at lacrimal sac site. The considered complication occurs after radioiodine therapy in dose of 150 mCi, the rate of occurrence is dose-dependent. There are no clinical guidelines for preventing this complication but there are reports of nasolacrimal duct preventive intubation and those about developing new drug agents that block an action of the protein that uptakes iodine in the nasolacrimal duct mucosa. For diagnosing, special diagnostic procedures and an ophthalmologist consultation are required. For the correction of this complication, conservative treatment (with low efficacy) and special surgical treatment are used, including nasolacrimal duct recanalization with different techniques and anastomosis between nasolacrimal duct and nasal cavity formation. In cases of early patient encounter, it is possible to use more functional and less invasive surgical techniques, in cases of late encounter, more invasive surgical techniques are used.

щитовидная железарадиоактивный йодслезоотводящие путивторичная облитерация слезоотводящих путейосложнениеthyroid glandradioactive iodinenasolacrimal ductnasolacrimal duct obstructioncomplicationReferencesРумянцев П.О., Коренев С.В. История появления терапии радиоактивным йодом. // Клиническая и экспериментальная тиреоидология. — 2015. — Т. 11. — № 4. — С. 51-55. [Rumiantsev PO, Korenev SV. The history of radioiodine therapy beginnings. Clinical and Experimental Thyroidology. 2015;11(4):51-55. (In Russ.)]. doi: https://doi.org/10.14341/ket2015451-55Румянцев П.О., Коренев С.В. История появления терапии радиоактивным йодом. // Клиническая и экспериментальная тиреоидология. — 2015. — Т. 11. — № 4. — С. 51-55. [Rumiantsev PO, Korenev SV. The history of radioiodine therapy beginnings. Clinical and Experimental Thyroidology. 2015;11(4):51-55. (In Russ.)]. doi: https://doi.org/10.14341/ket2015451-55Seidlin SM, Rossman I, et al. Radioiodine therapy of metastases from carcinoma of the thyroid; a 6-year progress report. J Clin Endocrinol Metab. 1949;9(11):1122-1137, Il lust. doi: https://doi.org/10.1210/jcem-9-11-1122Seidlin SM, Rossman I, et al. Radioiodine therapy of metastases from carcinoma of the thyroid; a 6-year progress report. J Clin Endocrinol Metab. 1949;9(11):1122-1137, Il lust. doi: https://doi.org/10.1210/jcem-9-11-1122Lee SL. Complications of radioactive iodine treatment of thyroid carcinoma. J Natl Compr Canc Netw. 2010;8(11):1277-1287. doi: https://doi.org/10.6004/jnccn.2010.0094Lee SL. Complications of radioactive iodine treatment of thyroid carcinoma. J Natl Compr Canc Netw. 2010;8(11):1277-1287. doi: https://doi.org/10.6004/jnccn.2010.0094Van nostrand D. The benefits and risks of i-131 therapy in patients with well-differentiated thyroid cancer. Thyroid. 2009;19(12):1381-1391. doi: https://doi.org/10.1089/thy.2009.1611Van nostrand D. The benefits and risks of i-131 therapy in patients with well-differentiated thyroid cancer. Thyroid. 2009;19(12):1381-1391. doi: https://doi.org/10.1089/thy.2009.1611Solans R, Bosch JA, Galofre P, et al. Salivary and lacrimal Gland dysfunction (Sicca Syndrome) after radioiodine therapy. J Nucl Med. 2001;42(5):738-743.Solans R, Bosch JA, Galofre P, et al. Salivary and lacrimal Gland dysfunction (Sicca Syndrome) after radioiodine therapy. J Nucl Med. 2001;42(5):738-743.Alexander C, Bader JB, Schaefer A, et al. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med. 1998;39(9):1551-1554.Alexander C, Bader JB, Schaefer A, et al. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med. 1998;39(9):1551-1554.Garreis F, Gottschalt M, Paulsen FP. Antimicrobial peptides as a major part of the innate immune defense at the ocular surface. Dev Ophthalmol. 2010;45:16-22. doi: https://doi.org/10.1159/000315016Garreis F, Gottschalt M, Paulsen FP. Antimicrobial peptides as a major part of the innate immune defense at the ocular surface. Dev Ophthalmol. 2010;45:16-22. doi: https://doi.org/10.1159/000315016Leder O. The significance of extrathyroidal radioactive iodine accumulation and secretion in clinical pathology. Histochemistry. 1982;74(4):585-588. doi: https://doi.org/10.1007/bf00496673Leder O. The significance of extrathyroidal radioactive iodine accumulation and secretion in clinical pathology. Histochemistry. 1982;74(4):585-588. doi: https://doi.org/10.1007/bf00496673Morgenstern KE, Vadysirisack DD, Zhang Z, et al. Expression of sodium iodide symporter in the lacrimal drainage system: implication for the mechanism underlying nasolacrimal duct obstruction in I131-treated patients. Ophthalmic Plast Reconstr Surg. 2005;21(5):337-344. doi: https://doi.org/10.1097/01.iop.0000179369.75569.a8Morgenstern KE, Vadysirisack DD, Zhang Z, et al. Expression of sodium iodide symporter in the lacrimal drainage system: implication for the mechanism underlying nasolacrimal duct obstruction in I131-treated patients. Ophthalmic Plast Reconstr Surg. 2005;21(5):337-344. doi: https://doi.org/10.1097/01.iop.0000179369.75569.a8Sakahara H, Yamashita S, Suzuki K, et al. Visualization of nasolacrimal drainage system after radioiodine therapy in patients with thyroid cancer. Ann Nucl Med. 2007;21(9):525-527. doi: https://doi.org/10.1007/s12149-007-0056-5Sakahara H, Yamashita S, Suzuki K, et al. Visualization of nasolacrimal drainage system after radioiodine therapy in patients with thyroid cancer. Ann Nucl Med. 2007;21(9):525-527. doi: https://doi.org/10.1007/s12149-007-0056-5Yuoness S, Rachinsky I, Driedger AA, Belhocine TZ. Differentiated thyroid cancer with epiphora: detection of nasolacrimal duct obstruction on I-131 Spect/Ct. Clin Nucl Med. 2011;36(12):1149-1152. Doi: Https://doi.org/10.1097/Rlu.0b013e3182336016Yuoness S, Rachinsky I, Driedger AA, Belhocine TZ. Differentiated thyroid cancer with epiphora: detection of nasolacrimal duct obstruction on I-131 Spect/Ct. Clin Nucl Med. 2011;36(12):1149-1152. Doi: Https://doi.org/10.1097/Rlu.0b013e3182336016Ali MJ, Vyakaranam AR, Rao JE, et al. Iodine-131 therapy and lacrimal drainage system toxicity: nasal localization studies using whole body nuclear scintigraphy and SPECT-CT. Ophthalmic Plast Reconstr Surg. 2017;33(1):13-16. doi: https://doi.org/10.1097/IOP.0000000000000603Ali MJ, Vyakaranam AR, Rao JE, et al. Iodine-131 therapy and lacrimal drainage system toxicity: nasal localization studies using whole body nuclear scintigraphy and SPECT-CT. Ophthalmic Plast Reconstr Surg. 2017;33(1):13-16. doi: https://doi.org/10.1097/IOP.0000000000000603Kloos RT, Duvuuri V, Jhiang SM, et al. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. 2002;87(12):5817-5820. doi: https://doi.org/10.1210/jc.2002-020210Kloos RT, Duvuuri V, Jhiang SM, et al. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. 2002;87(12):5817-5820. doi: https://doi.org/10.1210/jc.2002-020210Shepler TR, Sherman SI, Faustina MM, et al. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthalmic Plast Reconstr Surg. 2003;19(6):479-481. doi: https://doi.org/10.1097/01.IOP.0000092802.75899.F8Shepler TR, Sherman SI, Faustina MM, et al. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthalmic Plast Reconstr Surg. 2003;19(6):479-481. doi: https://doi.org/10.1097/01.IOP.0000092802.75899.F8Al-Qahtani KH, Al Asiri M, Tunio MA, et al. Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases. Clin Ophthalmol. 2014;8:2479-2484. doi: https://doi.org/10.2147/OPTH.S71708Al-Qahtani KH, Al Asiri M, Tunio MA, et al. Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases. Clin Ophthalmol. 2014;8:2479-2484. doi: https://doi.org/10.2147/OPTH.S71708Brockmann H, Wilhelm K, Joe A, et al. Nasolacrimal drainage obstruction after radioiodine therapy: case report and a review of the literature. Clin Nucl Med. 2005;30(8):543-545. doi: https://doi.org/10.1097/01.rlu.0000170013.84378.2aBrockmann H, Wilhelm K, Joe A, et al. Nasolacrimal drainage obstruction after radioiodine therapy: case report and a review of the literature. Clin Nucl Med. 2005;30(8):543-545. doi: https://doi.org/10.1097/01.rlu.0000170013.84378.2aBurns JA, Morgenstern KE, Cahill KV, et al. Nasolacrimal obstruction secondary to I131 therapy. Ophthalmic Plast Reconstr Surg. 2004;20(2):126-129. doi: https://doi.org/10.1097/01.iop.0000117340.41849.81Burns JA, Morgenstern KE, Cahill KV, et al. Nasolacrimal obstruction secondary to I131 therapy. Ophthalmic Plast Reconstr Surg. 2004;20(2):126-129. doi: https://doi.org/10.1097/01.iop.0000117340.41849.81Fonseca FL, Lunardelli P, Matayoshi S. Lacrimal drainage system obstruction associated to radioactive iodine therapy for thyroid carcinoma. Arq Bras Oftalmol. 2012;75(2):97-100.Fonseca FL, Lunardelli P, Matayoshi S. Lacrimal drainage system obstruction associated to radioactive iodine therapy for thyroid carcinoma. Arq Bras Oftalmol. 2012;75(2):97-100.Sun GE, Hatipoglu B. Epiphora after radioactive iodine ablation for thyroid cancer. Thyroid. 2013;23(2):243-245. doi: https://doi.org/10.1089/thy.2011.0186Sun GE, Hatipoglu B. Epiphora after radioactive iodine ablation for thyroid cancer. Thyroid. 2013;23(2):243-245. doi: https://doi.org/10.1089/thy.2011.0186Ali MJ. Iodine-131 therapy and nasolacrimal duct obstructions: what we know and what we need to know. Ophthalmic Plast Reconstr Surg. 2016;32(4):243-248. doi: https://doi.org/10.1097/IOP.0000000000000647Ali MJ. Iodine-131 therapy and nasolacrimal duct obstructions: what we know and what we need to know. Ophthalmic Plast Reconstr Surg. 2016;32(4):243-248. doi: https://doi.org/10.1097/IOP.0000000000000647Fard-Esfahani A, Farzanefar S, Fallahi B, et al. Nasolacrimal duct obstruction as a complication of iodine-131 therapy in patients with thyroid cancer. Nucl Med Commun. 2012;33(10):1077-1080. doi: https://doi.org/10.1097/MNM.0b013e3283570fb8Fard-Esfahani A, Farzanefar S, Fallahi B, et al. Nasolacrimal duct obstruction as a complication of iodine-131 therapy in patients with thyroid cancer. Nucl Med Commun. 2012;33(10):1077-1080. doi: https://doi.org/10.1097/MNM.0b013e3283570fb8Sagili S, Selva D, Malhotra R. Lacrimal scintigraphy: interpretation more art than science. Orbit. 2012;31(2):77-85. doi: https://doi.org/10.3109/01676830.2011.648797Sagili S, Selva D, Malhotra R. Lacrimal scintigraphy: interpretation more art than science. Orbit. 2012;31(2):77-85. doi: https://doi.org/10.3109/01676830.2011.648797da Fonseca FL, Yamanaka PK, Kato JM, Matayoshi S. Lacrimal system obstruction after radioiodine therapy in differentiated thyroid carcinomas: a prospective comparative study. Thyroid. 2016;26(12):1761-1767. doi: https://doi.org/10.1089/thy.2015.0657da Fonseca FL, Yamanaka PK, Kato JM, Matayoshi S. Lacrimal system obstruction after radioiodine therapy in differentiated thyroid carcinomas: a prospective comparative study. Thyroid. 2016;26(12):1761-1767. doi: https://doi.org/10.1089/thy.2015.0657Song H, Jeong J, Ju Koh M. Epiphora after radioactive iodine therapy in a low-risk patient. Clin Nucl Med. 2015;40(6):536-537. doi: https://doi.org/10.1097/RLU.0000000000000717Song H, Jeong J, Ju Koh M. Epiphora after radioactive iodine therapy in a low-risk patient. Clin Nucl Med. 2015;40(6):536-537. doi: https://doi.org/10.1097/RLU.0000000000000717Атькова Е.Л., Федоров А.А., Резникова Л.В., и др. Пятилетний опыт использования цитологического метода в дакриологии. // Вестник офтальмологии. — 2013. — Т. 129. — № 5. — С. 104-113. [At’kova EL, Fedorov AA, Reznikova LV, et al. Five-year application experience of cytological method in dacryological practice. Annals of ophtalmology. 2013;129(5):104-113. (In Russ.)].Атькова Е.Л., Федоров А.А., Резникова Л.В., и др. Пятилетний опыт использования цитологического метода в дакриологии. // Вестник офтальмологии. — 2013. — Т. 129. — № 5. — С. 104-113. [At’kova EL, Fedorov AA, Reznikova LV, et al. Five-year application experience of cytological method in dacryological practice. Annals of ophtalmology. 2013;129(5):104-113. (In Russ.)].Choontanom R. Probing and syringing with 3% solution of NaCl and/or 0.2 mg/ml mitomycin-C in nasolacrimal duct obstruction patients. J Med Assoc Thai. 2010;93(Suppl 6):S197-S202.Choontanom R. Probing and syringing with 3% solution of NaCl and/or 0.2 mg/ml mitomycin-C in nasolacrimal duct obstruction patients. J Med Assoc Thai. 2010;93(Suppl 6):S197-S202.Rumelt S. Primary treatment of nasolacrimal duct obstruction. J AAPOS. 2009;13(4):426; author reply 426-427. doi: https://doi.org/10.1016/j.jaapos.2009.04.003Rumelt S. Primary treatment of nasolacrimal duct obstruction. J AAPOS. 2009;13(4):426; author reply 426-427. doi: https://doi.org/10.1016/j.jaapos.2009.04.003Атькова Е.Л., Федоров А.А., Ярцев В.Д., Роот А.О. Разработка оптимального способа проведения баллонной дакрио пластики. // Вестник офтальмологии. — 2015. — Т. 131. — № 2. — С. 99-104. [At’kova EL, Fedorov AA, Yartsev VD, Root AO. Developing the optimal protocol for balloon dacryoplasty. Annals of ophtalmology. 2015;131(2):99-104. (In Russ.)]. doi: https://doi.org/10.17116/oftalma2015131299-104Атькова Е.Л., Федоров А.А., Ярцев В.Д., Роот А.О. Разработка оптимального способа проведения баллонной дакрио пластики. // Вестник офтальмологии. — 2015. — Т. 131. — № 2. — С. 99-104. [At’kova EL, Fedorov AA, Yartsev VD, Root AO. Developing the optimal protocol for balloon dacryoplasty. Annals of ophtalmology. 2015;131(2):99-104. (In Russ.)]. doi: https://doi.org/10.17116/oftalma2015131299-104Атькова Е.Л., Ярцев В.Д., Краховецкий Н.Н., Роот А.О. Малоинвазивные вмешательства при дакриостенозе: современные тенденции. // Вестник офтальмологии. — 2014. — Т. 130. — № 6. — С. 89-97. [At’kova EL, Iartsev VD, Krakhovetskii NN, Root AO. Minimally invasive surgery for dacryostenosis: modern trends. Annals of ophtalmology. 2014;130(6):89-97. (In Russ.)].Атькова Е.Л., Ярцев В.Д., Краховецкий Н.Н., Роот А.О. Малоинвазивные вмешательства при дакриостенозе: современные тенденции. // Вестник офтальмологии. — 2014. — Т. 130. — № 6. — С. 89-97. [At’kova EL, Iartsev VD, Krakhovetskii NN, Root AO. Minimally invasive surgery for dacryostenosis: modern trends. Annals of ophtalmology. 2014;130(6):89-97. (In Russ.)].Белоглазов В.Г. Альтернативные варианты восстановления проходимости слезоотводящих путей. // Вестник офтальмологии. — 2006. — Т. 122. — № 1. — С. 8-12. [Beloglazov VG. Alternatives to recovery of lacrimal duct patency. Annals of ophtalmology. 2006;122(1):8-12. (In Russ.)].Белоглазов В.Г. Альтернативные варианты восстановления проходимости слезоотводящих путей. // Вестник офтальмологии. — 2006. — Т. 122. — № 1. — С. 8-12. [Beloglazov VG. Alternatives to recovery of lacrimal duct patency. Annals of ophtalmology. 2006;122(1):8-12. (In Russ.)].Sweeney AR, Davis GE, Chang SH, Amadi AJ. Outcomes of endoscopic dacryocystorhinostomy in secondary acquired nasolacrimal duct obstruction: a case-control study. Ophthalmic Plast Reconstr Surg. 2018;34(1):20-25. doi: https://doi.org/10.1097/IOP.0000000000000841Sweeney AR, Davis GE, Chang SH, Amadi AJ. Outcomes of endoscopic dacryocystorhinostomy in secondary acquired nasolacrimal duct obstruction: a case-control study. Ophthalmic Plast Reconstr Surg. 2018;34(1):20-25. doi: https://doi.org/10.1097/IOP.0000000000000841Juniat VAR, Rajak S. The use of prophylactic Nunchaku stents to reduce the risk of nasolacrimal duct obstruction in patients with midfacial tumours undergoing radiotherapy. Orbit. 2017;36(5):298-300. doi: https://doi.org/10.1080/01676830.2017.1337182Juniat VAR, Rajak S. The use of prophylactic Nunchaku stents to reduce the risk of nasolacrimal duct obstruction in patients with midfacial tumours undergoing radiotherapy. Orbit. 2017;36(5):298-300. doi: https://doi.org/10.1080/01676830.2017.1337182

The authors declare that there are no conflicts of interest present.