甲状腺癌放射性碘治疗女性的生殖风险与生育力保存
本文为叙述性综述，总结放射性碘（RAI）治疗甲状腺癌后女性月经紊乱、短暂闭经、早绝经及抗苗勒管激素下降等生殖风险证据，并用SWOT分析评估RAI暴露前主动生育力保存的合理性，旨在支持循证咨询与决策。
要点
- RAI治疗与月经紊乱、短暂闭经和早绝经相关。
- 新兴证据显示RAI治疗后抗苗勒管激素水平下降。
- RAI生殖安全性未证实，暴露前生育力保存仍存争议。
核心结论
- RAI治疗对女性生殖健康存在潜在影响，但生殖安全性尚未证实，是否在暴露前主动提供生育力保存尚存争议。
研究设计与样本
- 叙述性综述，总结RAI治疗相关生殖风险证据，并用SWOT分析评估生育力保存的依据。
主要发现
- 多项研究显示甲状腺癌女性接受RAI后出现月经紊乱、短暂闭经和早绝经。
- 新兴证据显示RAI治疗与抗苗勒管激素水平下降相关。
临床怎么用
- 为育龄期甲状腺癌RAI候选者提供循证咨询与共同决策，权衡生育力保存的获益与风险。
局限性
- RAI治疗的生殖安全性尚未证实，相关证据存在不确定性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Radioactive iodine (RAI) therapy is widely used after thyroidectomy in differentiated thyroid cancer. As most of these patients are young women, the potential effects of RAI on reproductive health are of clinical importance. Several studies show menstrual irregularities, transient amenorrhoea and early menopause in women with thyroid cancer. Emerging evidence shows that RAI therapy is associated with a decline in anti-Müllerian hormone levels. As reproductive safety of RAI therapy has not been proven, it is debatable whether proactive fertility preservation should be offered before RAI exposure to safeguard reproductive autonomy. This narrative review summarizes the current evidence on the reproductive risks associated with RAI therapy, and the strengths, weaknesses, opportunities, and threats analysis evaluates the rationale for fertility preservation. The goal is to review benefits versus risks, areas of uncertainty and prospects for future research to support evidence-based counselling and decision-making in women of reproductive age who are candidates for RAI therapy for thyroid cancer.
引用
- Aktoz F, Gunes AC, Tercan C, et al. Reproductive risks and fertility preservation in women treated with radioactive iodine therapy for thyroid cancer. Reprod Biomed Online. 2026. PMID: 42217417. doi:10.1016/j.rbmo.2026.105744
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。