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Dietary evaluation of a low-iodine diet in Korean thyroid cancer patients preparing for radioactive iodine therapy in an iodine-rich region

  • Ju, Dal Lae (Department of Food Service and Nutrition Care, Seoul National University Hospital) ;
  • Park, Young Joo (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Paik, Hee-Young (Department of Food and Nutrition, Seoul National University) ;
  • Kim, Min-Ji (Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea) ;
  • Park, Seonyeong (Department of Internal Medicine, Seoul National University Hospital Biomedical Research Institute) ;
  • Jung, Kyong Yeun (Department of Internal Medicine, Eulji University Hospital) ;
  • Kim, Tae Hyuk (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Choi, Hun Sung (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Song, Yoon Ju (Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea)
  • Received : 2015.08.13
  • Accepted : 2015.10.28
  • Published : 2016.04.01

Abstract

BACKGROUND/OBJECTIVES: Despite the importance of a low-iodine diet (LID) for thyroid cancer patients preparing for radioactive iodine (RAI) therapy, few studies have evaluated dietary intake during LID. This study evaluated the amount of dietary iodine intake and its major food sources during a typical diet and during LID periods for thyroid cancer patients preparing for RAI therapy, and examined how the type of nutrition education of LID affects iodine intake. SUBJECTS/METHODS: A total of 92 differentiated thyroid cancer patients with total thyroidectomy were enrolled from Seoul National University Hospital. All subjects completed three days of dietary records during usual and low-iodine diets before $^{131}I$ administration. RESULTS: The median iodine intake was $290{\mu}g/day$ on the usual diet and $63.2{\mu}g/day$ on the LID. The major food groups during the usual diet were seaweed, salted vegetables, fish, milk, and dairy products and the consumption of these foods decreased significantly during LID. The mean energy intake on the LID was 1,325 kcal, which was 446 kcal lower than on the usual diet (1,771 kcal). By avoiding iodine, the intake of most other nutrients, including sodium, was significantly reduced during LID (P < 0.005). Regarding nutritional education, intensive education was more effective than a simple education at reducing iodine intake. CONCLUSION: Iodine intake for thyroid cancer patients was significantly reduced during LID and was within the recommended amount. However, the intake of most other nutrients and calories was also reduced. Future studies are needed to develop a practical dietary protocol for a LID in Korean patients.

Keywords

Low-iodine diet;thyroid cancer;radioactive iodine therapy;iodine intake;dietary record

Acknowledgement

Supported by : The Catholic University of Korea

References

  1. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015;47:127-41. https://doi.org/10.4143/crt.2015.060
  2. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-214. https://doi.org/10.1089/thy.2009.0110
  3. Kim TY, Kim WG, Kim WB, Shong YK. Current status and future perspectives in differentiated thyroid cancer. Endocrinol Metab (Seoul) 2014;29:217-25. https://doi.org/10.3803/EnM.2014.29.3.217
  4. Yi KH, Park YJ, Koong SS, Kim JH, Na DG, Ryu JS, Park SY, Park IA, Baek CH, Shong YK, Lee YD, Lee J, Lee JH, Chung JH, Jung CK, Choi SH, Cho BY. Revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Soc Radiol 2011;64:389-416. https://doi.org/10.3348/jksr.2011.64.4.389
  5. Kim WB, Seok JW, Kim MH, Kim BI, Park YJ, Lee KE, Lee SM, Lee YS, Jung KH, Jo YS, Cheon GJ, Chung JH, Kang SJ. Korean Thyroid Association guidelines for patients undergoing radioiodine therapy for differentiated thyroid cancers (First edition, 2012). J Korean Thyroid Assoc 2013;6:12-25. https://doi.org/10.11106/jkta.2013.6.1.12
  6. Sawka AM, Ibrahim-Zada I, Galacgac P, Tsang RW, Brierley JD, Ezzat S, Goldstein DP. Dietary iodine restriction in preparation for radioactive iodine treatment or scanning in well-differentiated thyroid cancer: a systematic review. Thyroid 2010;20:1129-38. https://doi.org/10.1089/thy.2010.0055
  7. Rohner F, Zimmermann M, Jooste P, Pandav C, Caldwell K, Raghavan R, Raiten DJ. Biomarkers of nutrition for development--iodine review. J Nutr 2014;144:1322S-1342S. https://doi.org/10.3945/jn.113.181974
  8. Zimmermann MB, Andersson M. Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes 2012;19:382-7. https://doi.org/10.1097/MED.0b013e328357271a
  9. Lee HS, Min H. Iodine intake and tolerable upper intake level of iodine for Koreans. Korean J Nutr 2011;44:82-91. https://doi.org/10.4163/kjn.2011.44.1.82
  10. Han MR, Ju DL, Park YJ, Paik HY, Song Y. An iodine database for common Korean foods and the association between iodine intake and thyroid disease in Korean adult. Int J Thyroidol. Forthcoming 2015.
  11. Bath SC, Sleeth ML, McKenna M, Walter A, Taylor A, Rayman MP. Iodine intake and status of UK women of childbearing age recruited at the University of Surrey in the winter. Br J Nutr 2014;112:1715-23. https://doi.org/10.1017/S0007114514002797
  12. Murray CW, Egan SK, Kim H, Beru N, Bolger PM. US Food and Drug Administration's Total Diet Study: dietary intake of perchlorate and iodine. J Expo Sci Environ Epidemiol 2008;18:571-80. https://doi.org/10.1038/sj.jes.7500648
  13. Sohn SY, Choi JY, Jang HW, Kim HJ, Jin SM, Kim SW, Suh S, Hur KY, Kim JH, Chung JH, Kim SW. Association between excessive urinary iodine excretion and failure of radioactive iodine thyroid ablation in patients with papillary thyroid cancer. Thyroid 2013;23:741-7. https://doi.org/10.1089/thy.2012.0136
  14. Yoo ID, Kim SH, Seo YY, Oh JK, O JH, Chung SK. The success rate of initial $^{131}I$ ablation in differentiated thyroid cancer: comparison between less strict and very strict low iodine diets. Nucl Med Mol Imaging 2012;46:34-40. https://doi.org/10.1007/s13139-011-0111-y
  15. Moon JA, Yoo CH, Kim MH, Lee SM, Oh YJ, Ryu YH, Lee YS, Chang HS, Park CS, Lee KE. Knowledge, self-efficacy, and perceived barriers on the low-iodine diet among thyroid cancer patients preparing for radioactive iodine therapy. Clin Nutr Res 2012;1:13-22. https://doi.org/10.7762/cnr.2012.1.1.13
  16. Kim JY, Kim KR. Dietary iodine intake and urinary iodine excretion in patients with thyroid diseases. Yonsei Med J 2000;41:22-8. https://doi.org/10.3349/ymj.2000.41.1.22
  17. Kim EH, Choi TI, Park YK. Dietary iodine intake and the association with subclinical thyroid dysfunction in male workers. Korean J Nutr 2012;45:218-28. https://doi.org/10.4163/kjn.2012.45.3.218
  18. Imaeda N, Kuriki K, Fujiwara N, Goto C, Tokudome Y, Tokudome S. Usual dietary intakes of selected trace elements (Zn, Cu, Mn, I, Se, Cr, and Mo) and biotin revealed by a survey of four-season 7-consecutive day weighed dietary records in middle-aged Japanese dietitians. J Nutr Sci Vitaminol (Tokyo) 2013;59:281-8. https://doi.org/10.3177/jnsv.59.281
  19. Jung HJ, Lee SE, Kim D, Noh H, Song S, Kang M, Song Y, Paik HY. Development and feasibility of a web-based program 'Diet Evaluation System (DES)' in urban and community nutrition survey in Korea. Korean J Health Promot 2013;13:107-15.
  20. Park JT 2nd, Hennessey JV. Two-week low iodine diet is necessary for adequate outpatient preparation for radioiodine rhTSH scanning in patients taking levothyroxine. Thyroid 2004;14:57-63. https://doi.org/10.1089/105072504322783858
  21. Tomoda C, Uruno T, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K, Miyauchi A. Reevaluation of stringent low iodine diet in outpatient preparation for radioiodine examination and therapy. Endocr J 2005;52:237-40. https://doi.org/10.1507/endocrj.52.237
  22. Choi JH, Kim HI, Park JW, Song EH, Ko BJ, Cheon GJ, Kim BI. Analysis of urine iodine excretion decrease by two-week stringent low iodine diet for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer; prospective study. Nucl Med Mol Imaging 2008;42:375-82.
  23. Chung JH. Low iodine diet for preparation for radioactive iodine therapy in differentiated thyroid carcinoma in Korea. Endocrinol Metab (Seoul) 2013;28:157-63. https://doi.org/10.3803/EnM.2013.28.3.157
  24. Kang TS, Lee JH, Leem D, Seo IW, Lee YJ, Yoon TH, Lee JH, Lee YJ, Kim YJ, Kim SG. Monitoring of Iodine in Foods for Estimation of Dietary Intake. Cheongwon: National Institute of Food and Drug Safety Evaluation; 2012.
  25. Nozu T, Yoshida Y, Ohira M, Okumura T. Severe hyponatremia in association with I(131) therapy in a patient with metastatic thyroid cancer. Intern Med 2011;50:2169-74. https://doi.org/10.2169/internalmedicine.50.5740
  26. Krishnamurthy VR, McDougall IR. Severe hyponatremia: a danger of low-iodine diet. Thyroid 2007;17:889-92. https://doi.org/10.1089/thy.2007.0094
  27. Kaewput C, Pusuwan P. Severe hyponatremia: a comorbidity with I131 therapy in a patient with papillary thyroid cancer. J Med Assoc Thai 2014.97:886-90.
  28. Kim SK, Yun GY, Kim KH, Park SK, Choi HY, Ha SK, Park HC. Severe hyponatremia following radioactive iodine therapy in patients with differentiated thyroid cancer. Thyroid 2014;24:773-7. https://doi.org/10.1089/thy.2013.0110

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