Radioactive iodine effects on ovarian reserve: a systematic review and metaanalysis
Quick Take: Radioactive iodine (RAI) therapy is associated with a significant, quantifiable reduction in ovarian reserve. Comprehensive fertility counseling is no longer optional; it is a prerequisite for treatment in reproductive-aged women.
💡 Clinical Impact
- Ovarian Toxicity: RAI exerts a direct detrimental effect on the follicular pool, as evidenced by a post-treatment decline in Anti-Müllerian Hormone (AMH) levels.
- Standardized Counseling: This data necessitates the immediate integration of fertility preservation (FP) specialists into the thyroid cancer and hyperthyroidism care team.
- Protocol Shift: Pre-treatment ovarian reserve assessment should serve as the baseline for all women of childbearing potential.
📊 Evidence Breakdown
Evidence Grade: 🟡 7/10 (Moderate-Strong)
Analysis: This systematic review and meta-analysis confirms a statistically significant drop in ovarian reserve markers following RAI. While the degree of long-term recovery varies, the acute impact is well-documented.
Note: Heterogeneity in dosing (mCi) across studies suggests that the "dose-response" relationship requires further granular mapping.
🩺 Practice Recommendation
Mandatory Pre-Treatment Action: Do not initiate RAI in reproductive-aged women without a documented fertility counseling session. Incorporate baseline AMH testing and provide a formal referral to Reproductive Endocrinology and Infertility (REI) if treatment can be safely delayed for egg or embryo cryopreservation.