RADIATION PNEUMONITIS AND FIBROSIS: A COMPLICATION OF RADIOIODINE TREATMENT OF PULMONARY METASTASES FROM CANCER OF THE THYROID*

Abstract

INTRODUCTION THIS paper has been prompted by the observation that large doses of radioiodine given to patients with pulmonary metastases from thyroid cancer may produce severe pulmonary damage. Although this is a complication of radioiodine therapy heretofore unreported, it has been observed following roentgen irradiation directed to the chest. From the latter studies, the pathologic anatomy of radiation-induced pulmonary fibrosis and a rough notion of the dosage of x-ray irradiation required to produce it, has been obtained (1, 2). The present report describes in some detail the histories of 2 patients in whom fatal pulmonary fibrosis and pneumonitis developed. It also describes briefly our experience in other patients with pulmonary metastases from carcinoma of the thyroid who received one or more large doses of I¹³¹. Two of these patients have symptoms of pulmonary insufficiency, probably secondary to pulmonary fibrosis. CLINICAL MATERIAL AND METHODS Radioiodine as I¹³¹ was given orally in doses ranging from 107 mc. to 355 mc. All doses were in millicuries conforming to the National Bureau of Standards. In previous publications from this laboratory, the New York Hospital physicists' “millicurie” was used, which is equivalent to 1.2 millicuries in terms of the National Bureau of Standards. Urine and blood were analyzed for radioactivity as described previously (3).