Objective: Radioactive iodine (RAI) ablation therapy is widely used in the management of differentiated thyroid cancer (DTC). However, its potential adverse effects on ovarian reserve in premenopausal women remain an important clinical concern. This study aimed to investigate the association between RAI ablation therapy and ovarian reserve in premenopausal patients with differentiated thyroid cancer. Materials and Methods: This study included 66 premenopausal women aged 18–45 years with DTC. Among these patients, 46 received RAI therapy and 20 did not. Serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and thyroid-stimulating hormone (TSH) levels were measured. To evaluate in-dependent association between RAI therapy and ovarian reserve, a multivariable linear regres-sion analysis was performed with AMH as the dependent variable. Results: AMH levels were significantly lower in patients who received RAI therapy compa-red with those who did not (1.34 ± 0.37 ng/mL vs 1.79 ± 0.25 ng/mL, p = 0.001). No signifi-cant differences were observed between the groups in serum FSH, LH, or E2 levels. AMH levels did not differ significantly according to RAI dose categories of 75, 100, and 150 mCi (p = 0.073). In the multivariable linear regression analysis, RAI therapy remained indepen-dently associated with lower AMH levels (β = −0.41, p = 0.003). Age was also independently associated with AMH levels (β = −0.36, p = 0.010). Conclusion: RAI therapy was associated with lower AMH levels in premenopausal women with DTC, suggesting a potential adverse effect on ovarian reserve. Larger prospective studies are needed to confirm these findings.
Cite this Article As :
Gurbuz AF, Ucler R, Alay M, Alp HH. Effect of Radioactive Lodine Ablation Therapy on Ovarian Reserve in Patients with Differentiated Thyroid Cancer.
Selcuk Med J 2026;42(2): 151-157
1. Republic of Türkiye Ministry of Health, General Directorate of Public Health.
Turkey Cancer Statistics 2020. Ankara: Ministry of Health of Türkiye; 2023. doi: not available.
2. Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2021;71(3):209–249. doi:10.3322/caac.21660.
3. Wu JX, Young S, Ro K, et al. Reproductive outcomes and nononcologic complications after radioactive iodine ablation for well-differentiated thyroid cancer. Thyroid. 2015;25(1):133–138. doi:10.1089/thy.2014.0335.
4. Anderson RA, Remedios R, Kirkwood AA, Patrick P, Stevens L, Clifton-Hadley L, et al. The impact of cancer therapy on female reproductive function. Lancet Diabetes Endocrinol. 2020;8(3):240–252. doi:10.1016/S2213-8587(19)30392-
5. Ringel MD, Sosa JA, Baloch Z, et al.2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer.Thyroid.2025;35(8):841-985.doi:10.1177/10507256251363120
6. La Marca A, Giulini S, Tirelli A, et al. Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007;22(3):766–771. doi:10.1093/humrep/del421.
7. Cook CL, Siow Y, Taylor S, Fallat ME. Serum Müllerian-inhibiting substance levels during normal menstrual cycles. Fertil Steril. 2000;73(4):859–861. doi:10.1016/S0015-0282(99)00695-6.
8. Trunnell JB, Marinelli LD. The treatment of metastatic thyroid cancer with radioactive iodine: credits and debits. J Clin Endocrinol Metab. 1949;9:1138–1152. doi: not available.
9. Ceccarelli C, Bencivelli W, Morciano D, et al. ¹³¹I therapy for differentiated thyroid cancer leads to an earlier onset of menopause: results of a retrospective study. J Clin Endocrinol Metab. 2001;86(8):3512–3515. doi:10.1210/jcem.86.8.7731.
10. Raymond JP, Izembart M, Marliac V, et al. Temporary ovarian failure in thyroid cancer patients after thyroid remnant ablation with radioactive iodine. J Clin Endocrinol Metab. 1989;69(1):186–190. doi:10.1210/jcem-69-1-186.
11. Sawka AM, Lakra DC, Lea J, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf). 2008;69(3):479–490. doi:10.1111/j.1365-2265.2008.03169.x.
12. Chow SM, Yau S, Lee SH, et al. Pregnancy outcome after diagnosis of differentiated thyroid carcinoma: no deleterious effect after radioactive iodine treatment. Int J Radiat Oncol Biol Phys. 2004;59(4):992–1000. doi:10.1016/j.ijrobp.2004.02.051.
13. Sarkar SD, Beierwaltes WH, Gill SP, et al. Subsequent fertility and birth histories of children and adolescents treated with ¹³¹I for thyroid cancer. J Nucl Med. 1976;17(6):460–464. doi: not available.
14. Garsi JP, Schlumberger M, Rubino C, et al. Therapeutic administration of ¹³¹I for differentiated thyroid cancer: radiation dose to ovaries and outcome of pregnancies. J Nucl Med. 2008;49(5):845–852. doi:10.2967/jnumed.107.048041.
15. Bal C, Kumar A, Tripathi M, et al. High-dose radioiodine treatment for differentiated thyroid carcinoma is not associated with change in female fertility or genetic risk to offspring. Int J Radiat Oncol Biol Phys. 2005;63(2):449–455. doi:10.1016/j.ijrobp.2005.02.036.
16. Acıbucu F, Acıbucu DO, Akkar OB, et al. Evaluation of ovarian reserve with anti-Müllerian hormone level in patients with well-differentiated thyroid cancer receiving radioactive iodine ablation treatment. Exp Clin Endocrinol Diabetes. 2016;124(10):593–596. doi:10.1055/s-0042-109571.
17. Yaish I, Azem F, Gutfeld O, et al. A single radioactive iodine treatment has a deleterious effect on ovarian reserve in women with thyroid cancer: results of a prospective pilot study. Thyroid. 2018;28(4):522–527. doi:10.1089/thy.2017.0364.
18. Evranos B, Faki S, Polat SB, et al. The effects of radioactive iodine therapy on ovarian reserve: a prospective pilot study. Thyroid. 2018;28(12):1702–1707. doi:10.1089/thy.2018.0271.
19. La Marca A, Sighinolfi G, Radi D, et al. Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology. Hum Reprod Update. 2010;16(2):113–130. doi:10.1093/humupd/dmp036.
20. Giusti M, Mittica M, Comite P, et al. Anti-Müllerian hormone in premenopausal females after ablative radioiodine treatment for differentiated thyroid cancer. Endocrine. 2018;60(3):516–523. doi:10.1007/s12020-018-1557-6.
21. Lee JE, Yoon SH, Kim HO, Min EG. Correlation between the serum luteinizing hormone-to-follicle-stimulating hormone ratio and anti-Müllerian hormone levels in normo-ovulatory women. J Korean Med Sci. 2015;30(3):296–300. doi:10.3346/jkms.2015.30.3.296.
22. Dewailly D, Andersen CY, Balen A, et al. The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update. 2014;20(3):370–385. doi:10.1093/humupd/dmt062.
23. Kruszyńska A, Słowińska-Srzednicka J. Anti-Müllerian hormone (AMH) as a good predictor of time of menopause. Menopause Rev. 2017;16(2):47–50. doi:10.5114/pm.2017.68592.
24. Kim HO, Yoon SH, Lee JH, et al. Impact of radioactive iodine therapy on ovarian reserve in women with differentiated thyroid cancer. Thyroid. 2021;31(7):1069–1076. doi:10.1089/thy.2020.0675.
25. Anderson RA, Remedios R, Kirkwood AA, et al. The impact of cancer therapy on female reproductive function: mechanisms and clinical implications. Lancet Dia-betes Endocrinol. 2020;8(3):240–252. doi:10.1016/S2213-8587(19)30392-4.
26. Lamartina L, Grani G, Durante C, et al. Long-term reproductive outcomes in thyroid cancer survivors. Endocrine. 2022;75(1):1–9. doi:10.1007/s12020-021-02888-0.
27. Rizzo L, Vanni E, Rossi ED, et al. Fertility and pregnancy outcomes after radioac-tive iodine treatment in women with differentiated thyroid cancer. Thyroid. 2023;33(2):219–226. doi:10.1089/thy.2022.0421.