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Article

Role of Hyaluronic Acid and Chondroitin Sulphate in Protecting Urinary Epithelium in Patients Operated for Differentiated Thyroid Cancer Undergoing Ablation Therapy with Iodine-131

by
Giuseppe Campagna
1,*,
Chiara Lauri
1,
Tiziana Lanzolla
2,
Anna Festa
2,
Luciano Carideo
1 and
Alberto Signore
1,2
1
Nuclear Medicine Unit, Department Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00189 Rome, Italy
2
Nuclear Medicine Unit, University Hospital “Sant’Andrea”, 00189 Rome, Italy
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(19), 3154; https://doi.org/10.3390/cancers17193154
Submission received: 25 July 2025 / Revised: 24 September 2025 / Accepted: 25 September 2025 / Published: 28 September 2025
(This article belongs to the Special Issue Updates on Thyroid Cancer)
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Abstract

Simple Summary

The administration of hyaluronic acid and chondroitin sulphate has shown protective properties on the urinary epithelium in several different clinical conditions. We, therefore, explored the possible role of hyaluronic acid and chondroitin sulphate in preventing iodine-131-induced urinary infections in patients treated for thyroid cancer, while assessing whether urinary infections are related to doses of iodine-131 or patients’ preparation. To these purposes, several urine parameters were analyzed at basal time and up to one week. Our results show that urinary infections occur in a relevant percentage of patients undergoing iodine-131, either in patients who were treated with hyaluronic acid and chondroitin sulphate or in patients who were not. Nevertheless, in patients who experienced urinary infections, the use of hyaluronic acid and chondroitin sulphate was able to reduce the epithelial cells and bacteria count in urine. Therefore, similarly to other different clinical conditions, the use of hyaluronic acid and chondroitin sulphate could be a valid option in patients undergoing iodine-131 for thyroid cancer ablation to mitigate urinary infections.

Abstract

Background: It is not clear if the administration of iodine-131 in patients with differentiated thyroid cancers induces relevant cystitis and lower urinary tract infections (UTIs). The aim of this study was to evaluate the impact of oral administration of hyaluronic acid and chondroitin sulphate (HA&CS) on the frequency of UTIs induced by iodine-131. Methods: In this study, 166 female patients with a surgical diagnosis of differentiated thyroid cancer who were hospitalized in Sant ’Andrea Hospital of Rome to undergo the first cycle of therapy with iodine-131 for thyroid remnant ablation were evaluated. Sixty-one patients were treated with HA&CS for 8 days, and thirty-nine patients were treated with HA&CS for 17 days. Sixty-six patients were not treated with HA&CS and were used as control subjects. Patients underwent urinalysis at different time points: immediately before 131I therapy, two days later, and one week later. Patients were divided in six groups based on whether they received the treatment with HA&CS, its duration, and whether they developed a UTI: group A, n = 51 patients who did not receive HA&CS and did not develop UTI; group B1, n = 37 patients treated with HA&CS for 8 days and did not develop UTI; group B2, n = 29 patients treated with HA&CS for 17 days and did not develop UTI; group C, n = 15 patients who did not receive HA&CS and developed UTI; group D1, n = 24 patients treated with HA&CS for 8 days and developed UTI; group D2, n = 10 patients treated with HA&CS for 17 days and developed UTI. Results: The bacteria count, red blood cells and white blood cells did not change when group A was compared to both group B1 and group B2, while pH and epithelial cells showed a decrease over time when comparing group A and group B2 (p = 0.01 and p < 0.0001, respectively). Comparing group C with group D1 and group D2, patients who did not receive HA&CS (group C) showed a higher bacteria and epithelial cell count compared to those who were pre-treated with HA&CS. Conclusions: HA&CS could be an effective supportive therapy to prevent and mitigate UTIs in patients treated with 131I.

1. Introduction

Thyroid cancer is by far the most common endocrine tumour, and its incidence is constantly rising [1]. The most frequent histotypes are well-differentiated thyroid cancers (DTCs), which include papillary thyroid cancer and follicular thyroid cancer, that account for about 90% of malignant thyroid tumours [2]. DTC benefits from nuclear-medicine therapy with 131I, either using low doses, with the purpose to ablate residual thyroid tissue after total or near-total thyroidectomy, or high doses aiming to treat any possible locoregional recurrences or lymph nodal, bone or pulmonary iodine-avid metastases [3,4]. When orally administered, iodine-131 is eliminated from the human body mainly through the urinary tract (37–75%), partly from fecal elimination (10%) and triflingly through sweat.
Therefore, not surprisingly, the ureters, the bladder and the urethra are the tissues receiving the highest radiation dose, followed by the kidneys [5,6,7]. Despite this, urinary side effects are rarely reported, with the most relevant adverse effects of radioiodine therapy being nausea, neck pain, salivary and lacrimal gland dysfunction and altered taste. Subacute and late adverse effects can be infertility, sialoadenitis, nasolacrimal duct obstruction and second primary malignancy [6,7,8,9], mostly depending on cumulative radiation dose.
Although rarely reported by patients, we hypothesized that sub-clinical or clinically relevant cystitis and lower urinary tract infections (UTIs) may represent a possible side effect of radioiodine therapy, particularly in female patients.
Indeed, nothing is known about the frequency and severity of UTIs in patients treated with 131I, nor if there is a dose-dependent effect, nor if the use of recombinant human thyroid-stimulating hormone (rhTSH) may increase or decrease such frequency, since it accelerates urinary elimination of free 131I. Furthermore, taking into account the prevalence of DTC and that many patients undergo radioiodine therapy after surgery, and considering that UTIs often may remain unknown and thus not treated, it could be clinically relevant to investigate how to prevent these side effects.
Radiation cystitis symptoms include a persistent urge to void, burning sensation during voiding, pollakiuria, pelvic discomfort, feeling pressure in the lower abdomen, hematuria and urine smell alterations.
The administration of hyaluronic acid and chondroitin sulphate (HA&CS) has shown protective properties on urinary epithelium in several different clinical conditions [10,11,12,13,14,15,16,17,18]. Amongst this class, Ialuril® Soft Gels (IBSA, Lodi (LO) Italy) is a gluten-free and lactose-free dietary supplement, based on curcumin, quercetin, hyaluronic acid and chondroitine sulphate, which shows anti-inflammatory and analgesic properties and has the ability to create a protective biofilm on the urothelium, thus preventing bacteria attachment to uroepithelium [12]. In particular, the presence of curcumin has antioxidant properties, while quercetin, a flavonol abundant in fruit and vegetables, allows the intestinal absorption of curcumin and also exerts inflammatory and antibacterial effects [19,20,21,22].
The improvement of urinary symptoms and acute genito-urinary toxicity by the administration of HA&CS has been confirmed by several studies [10,11,23,24,25,26,27].
Since the oxidative stress with REDOX homeostasis imbalance has been largely described after 131I treatment for DTC [28,29,30], attention is focused on the use of antioxidants to prevent 131I side effects [31,32].
The aims of our study were as follows: to examine the frequency of UTIs in patients with DTC undergoing 131I therapy; to assess if UTIs are 131I dose-dependent; to determine if the preparation of patients for 131I therapy with hypothyroidism or rhTSH may influence the frequency of UTIs and, finally, to explore if the administration of HA&CS can reduce the frequency of UTIs or urinary tract epithelium alterations induced by 131I.

2. Patients and Methods

2.1. Study Design and Patients

We retrospectively evaluated a total of 166 female patients (from 20 to 80 years, mean age: 49.8 years) with surgical diagnosis of DTC (both papillary and follicular histotypes) who were hospitalized in the Nuclear Medicine Unit of Sant’Andrea Hospital of Rome between October 2015 and November 2019 to undergo the first cycle of therapy with iodine-131 for remnant ablation purposes. Male patients were excluded because they are usually less subject to lower UTIs than females for anatomic/physiologic reasons, as also shown by a pilot analysis that we previously performed. We also excluded all those patients with a history of congenital or surgical urinary tract alterations, patients with renal failure, urinary tract obstruction or with a neurogenic bladder.
Patients received both low (50–80 mCi; n = 80 patients) and high-doses (100, 120 and 150 mCi; n = 86 patients) of 131I based on post-surgical staging. According to guidelines [2,5], for patient preparation to radioiodine administration, 120 subjects received rhTSH injections for two days before therapy, while the other 46 patients underwent thyroid hormone withdrawal.
We divided our population in six groups (Figure 1): group A (n = 51) patients who underwent radioiodine therapy without HA&CS administration and did not develop UTI; group B1 (n = 37) patients treated with two capsules of HA&CS per day (morning and evening) starting the day before radioiodine therapy and for the following 7 days (8 days total) and did not develop UTI; group B2 (n = 29) patients who received two capsules of HA&CS per day starting 10 days before therapy until one week after (17 days total) and did not develop UTI; group C (n = 15) patients who underwent radioiodine therapy without HA&CS and developed UTI; group D1 (n = 24) patients who received two capsules of HA&CS for 8 days total and developed UTI and group D2 (n = 10) patients who received two capsules of HA&CS for 17 days total and developed UTI.
Moreover, we analyzed three further groups: groups A + C (n = 66), groups B1 + D1 (n = 61) and groups B2 + D2 (n = 39) to assess the differences in UTI development, according to the treatment with HA&CS and its duration.
Finally, we performed additional analyses to assess whether the infection is dependent on 131I dose or patients’ preparation (rhTSH vs. hypothyroidism).

2.2. Urine Analysis

Urine analysis was performed prior to therapy at the time of hospitalization, two days after radioiodine administration and one week after therapy. Bacteria count, epithelial cells (EPs), pH, red blood cells (RBCs), and white blood cells (WBCs) were collected at each time point.

2.3. Ethical Aspects

Our study included a retrospective analysis of data acquired and recorded in an internal archive of the Nuclear Medicine Unit of Sant’Andrea Hospital of Rome; the local Ethics Committee was notified on 10 February 2015. Since hyaluronic acid was already commercially available and used in clinical practice, a protocol number was not required. Each patient provided informed consent, dated and signed. Patients’ data were anonymized and included in a database.

2.4. Statistical Analysis

Continuous variables were shown as mean ± standard deviation (SD) and at a 95% confidence interval (95%CI).
Comparisons of urine parameters between hypothyroidism and rhTSH were evaluated by the Student t test (verified normality) and the Welch test (failed normality).
Longitudinal data analysis of bacteria, epithelial cells (EPs), pH, RBCs, and WBCs and the comparison between the groups was performed using a Generalized Linear Mixed Model method (GLIMMIX) with repeated measures, along with the distribution of data fixed as Gaussian.
The distribution data (urine parameters) and residuals were tested by the Shapiro–Wilk test and checking the Q-Q plot, while the homoscedasticity was verified by checking the studentized residuals vs. the fitted values plot.
A p-value < 0.05 was considered statistically detectable. All statistical analyses and the graphics were performed using SAS v.9.4 and/or JMP Pro v. 16.0 (SAS Institute Inc., 100 SAS Campus Drive, Cary, NC, 27513-2414, USA).

3. Results

Overall, in our series, a lower UTI was observed in 49 out of 166 patients (29.5%) and, in particular, in 15 out of 66 patients (22.7%) who were not treated with HA&CS and in 34 out of 100 patients who were treated (39.3% in the group treated for 8 days and 25.6% in the group treated for 17 days, respectively) without no significant differences neither between pre-treated and non-pretreated groups (p = 0.12), nor according to HA&CS duration (p = 0.16).
No differences in urine parameters were observed in non-infected patients regardless of the 131I dose (Table 1) or their preparation (with rhTSH or hypothyroidism (Table 2 and Table 3)).
When comparing non-infected patients without HA&CS pre-treatment (group A; mean age ± SD: 53.06 ± 12.97; min: 19.41 and max: 75.54 years) and non-infected patients with HA&CS for 8 days (group B1; mean age ± SD: 52.78 ± 13.84; min: 19.07 and max: 81.14 years), no detectable differences were observed in terms of pH, bacteria, EP, RBC and WBC count. When comparing group A and group B2 (non-infected patients with HA&CS for 17 days; mean age ± SD: 51.91 ± 13.18; min: 19.64 and max: 72.85 years), bacteria, RBC and WBC count were not statistically different, while EP and pH values were statistically higher in group A (p = 0.01, p < 0.0001, respectively).
When comparing infected patients without HA&CS pre-treatment (group C; mean age ± SD: 41.09 ± 9.39; min: 23.39 and max: 57.45 years), and infected patients with HA&CS for 8 days (group D1; mean age ± SD: 46.02 ± 13.04; min: 25.82 and max: 81.66 years), bacteria and EP count were statistically higher in non-treated patients (p < 0.0001 and p = 0.002, respectively) and bacteriuria was higher at both the second day (group C: 2.80 ± 0.79; 95%CI: 2.24 to 3.36 vs. group D1: 1.79 ± 0.78; 95%CI: 1.46 to 2.12, p = 0.002) and at the seventh day (group C: 2.90 ± 1.20; 95%CI: 2.04 to 3.76 vs. group D1: 1.50 ± 0.51; 95%CI: 1.28 to 1.72, p = 0.0009).
Group C also showed a statistically higher bacteria and EP count compared to infected patients with HA&CS for 17 days (group D2; mean age ± SD: 36.43 ± 10.37; min: 26.51 and max: 58.97 years) (p = 0.0005 and p = 0.001, respectively). Bacteria count was statistically higher at any time point: group C (baseline): 2.50 ± 0.53; 95%CI: 2.12 to 2.88 vs. group D2 (baseline): 1.70 ± 0.48; 95%CI: 1.35 to 2.05, p = 0.009; group C (second day): 2.80 ± 0.79; 95%CI: 2.24 to 3.36 vs. group D2 (second day): 1.50 ± 0.53; 95%CI: 1.12 to 1.88, p = 0.007; group C (seventh days): 2.90 ± 1.20; 95%CI: 2.04 to 3.76 vs. group D2 (second days): 1.80 ± 0.42; 95%CI: 1.50 to 2.10, p = 0.02.
By comparing non-treated patients with and without UTI (group A + C; mean age ± SD: 50.34 ± 13.19; min: 19.41 and max: 75.54 years) and patients treated with HA&CS for 8 days, both infected and non-infected (groups B1 + D1; mean age ± SD: 50.12 ± 13.83; min: 19.07 and max: 81.66 years), we did not observe any detectable difference in terms of bacteria, EP, pH, RBC and WBC count.
By comparing non-treated patients with and without UTI (groups A + C) and patients treated with HA&CS for 17 days, both infected and non-infected (groups B2 + D2; mean age ± SD: 47.94 ± 14.16; min: 19.64 and max: 72.85 years), EP and pH count were higher in non-treated patients (p = 0.008 and p < 0.0001, respectively), while no significant differences were observed in terms of bacteria, RBC and WBC count. At seventh day non-HA&CS-treated patients showed statistically higher bacteriuria (1.54 ± 1.01; 95%CI: 1.28 to 1.80 vs. 1.21 ± 0.41; 95%CI: 1.07 to 1.34, p = 0.03).
Figure 2 and Figure 3 show the comparisons between group A and group B1 and B2, respectively, at baseline, second day, and seventh day, in terms of EP, pH, RBC and WBC count. Between group A and group B1, only pH showed a detectable difference at the second day (p = 0.01), while in all other temporal comparisons, we did not observe statistically relevant differences in terms of EP, pH, RBC, and WBC count (Figure 2). When comparing group A and B2 (Figure 3), relevant differences were detected for EP (p = 0.03) and pH (p = 0.007) at the second day, and for pH (p < 0.0001) and WBC (p = 0.03), at the seventh day.
Figure 4 and Figure 5 show the comparison between group C and group D1 and D2, respectively, at baseline, on the second day and seventh day, in terms of EP, pH, RBC and WBC. Only EP showed a detectable difference on the seventh day when comparing group C with group D1 and D2 (p < 0.0001 and p = 0.0003, respectively).
Comparing groups A + C and groups B1 + D1, we observed a difference for EP (p = 0.001) on the seventh day, for pH (p = 0.005) on the second day and at baseline for WBC (p = 0.01) (Figure 6). Comparing groups A + C and groups B2 + D2, again, we observed differences for EP and pH on the second day (p = 0.01 and p = 0.002, respectively) and on the seventh day (p = 0.003 and p < 0.0001, respectively) and for WBC on the seventh day (p = 0.02) (Figure 7).
All the groups were matched by age; indeed, comparing the age for each group, no statistically detectable differences were observed (A vs. B1, p = 0.92; A vs. B2, p = 0.71; C vs. D1, p = 0.21; C vs. D2, p = 0.26; A + C vs. B1 + D1, p = 0.93; A + C vs. B2 + D2, p = 0.38).

4. Discussion

With the increase in life expectancy and of diagnostic procedures, the number of thyroidectomies and 131I treatments has rapidly grown, and the attention has shifted to preventing or reducing 131I side effects. It is now more clear that DTC patients need a multidisciplinary approach, especially in patients with several comorbidities, and this should also include the adoption of anti-oxidative compounds or diet to reduce REDOX imbalance induced by 131I [28,29,33].
To the best of our knowledge, this is the first study addressing the possible role of HA&CS in reducing the risk of UTI in patients undergoing both high and low doses of 131I for thyroid remnant ablation.
Despite a relevant proportion of patients treated with HA&CS who developed a UTI, our results show that HA&CS is able to reduce EP and bacteria count both within 8 days and within 17 days of administration in infected patients.
Also, the pH is affected by the positive effect of the use of HA&CS; indeed, when considering the non-infected patients, those who received HA&CS for 17 days showed lower pH values; when comparing the combination of both infected and non-infected patients without HA&CS (groups A + C) and both infected and non-infected patients with HA&CS for 17 days (groups B2 + D2), the administration of HA&CS was associated with lower pH values.
This study has several limitations: first of all, it is a retrospective single-centre study; therefore, external validity and generalizability might be hampered. Moreover, potential confounders, such as possible baseline differences regarding the risk factors for UTI (diabetes, hydration status, prior catheter use, etc.), were not considered, thus possibly introducing a detection bias. In addition to this, urinalysis up to one week post-131I therapy might not be sufficient to detect possible longer-term effects on UTI incidence in patients undergoing radio-metabolic therapy for thyroid remnant ablation. Finally, we did not systematically explore urinary discomfort or pain in patients who developed UTI, thus we cannot reach any conclusion on the possible role of HA&CS on patients’ quality of life.
Nevertheless, despite these limitations, our results show that the effect of HA&CS on EP and bacteria counts is evident after 8 days and is maintained at 17 days. Based on these results, we could conclude that 8 days are enough to improve urinary parameters in UTI in patients operated on for differentiated thyroid cancer undergoing ablation therapy with 131I.

5. Conclusions

The use of HA&CS for 8 days in patients operated on for DTC undergoing ablation therapy with 131I leads to a reduction in EP and bacteria count in the urine of patients with lower UTI and could therefore be taken into consideration to mitigate urine parameters in patients with infection.

Author Contributions

Conceptualization, G.C.; Data curation, T.L. and A.F.; Formal analysis, G.C.; Investigation, L.C. and C.L.; Methodology, A.S., G.C. and C.L.; Validation, A.S. and G.C.; Writing—original draft, G.C.; Writing—review and editing, A.S. and G.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki. Since our study includes a retrospective analysis of data routinely acquired and registered in an internal archive of the Nuclear Medicine UOC, the local ethics committee was notified on 10 February 2015. A protocol number is not required because hyaluronic acid is used in clinical practice and the supplement was already on the market before the study was conducted.

Informed Consent Statement

All patients gave informed consent for inclusion in the study.

Data Availability Statement

The original data presented in the study are available by writing to the first author.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

131IIodine-131
95%CI95% Confidence interval
DTCDifferentiated thyroid cancer
EPsEpithelial cells
HA&CSHyaluronic acid and chondroitin sulphate
RBCsRed blood cells
rhTSHRecombinant human thyroid-stimulating hormone
UTIsUrinary tract infections
WBCsWhite blood cells

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Cancers 17 03154 g001
Figure 1. Flow-chart of the population.
Figure 1. Flow-chart of the population.
Cancers 17 03154 g001
Cancers 17 03154 g002
Figure 2. Violin-box-plot of epithelial cells, pH, red blood cells, and white blood cells according to time in “non-infected without HA&CS” vs. “non-infected with HA&CS for 8 days”.
Figure 2. Violin-box-plot of epithelial cells, pH, red blood cells, and white blood cells according to time in “non-infected without HA&CS” vs. “non-infected with HA&CS for 8 days”.
Cancers 17 03154 g002
Cancers 17 03154 g003
Figure 3. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “non-infected without HA&CS” and “non-infected with HA&CS for 17 days”.
Figure 3. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “non-infected without HA&CS” and “non-infected with HA&CS for 17 days”.
Cancers 17 03154 g003
Cancers 17 03154 g004
Figure 4. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “infected without HA&CS” vs. “infected with HA&CS for 8 days”.
Figure 4. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “infected without HA&CS” vs. “infected with HA&CS for 8 days”.
Cancers 17 03154 g004
Cancers 17 03154 g005
Figure 5. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “infected without HA&CS” vs. “infected with HA&CS for 17 days”.
Figure 5. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “infected without HA&CS” vs. “infected with HA&CS for 17 days”.
Cancers 17 03154 g005
Cancers 17 03154 g006
Figure 6. Violin-box-plot of epithelial cells, pH, red blood cells, and white blood cells according to time in “non-infected without HA&CS + infected without HA&CS” vs. “non-infected with HA&CS for 8 days + infected with HA&CS for 8 days”.
Figure 6. Violin-box-plot of epithelial cells, pH, red blood cells, and white blood cells according to time in “non-infected without HA&CS + infected without HA&CS” vs. “non-infected with HA&CS for 8 days + infected with HA&CS for 8 days”.
Cancers 17 03154 g006
Cancers 17 03154 g007
Figure 7. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “non-infected without HA&CS + infected without HA&CS” vs. “non-infected with HA&CS for 17 days + infected with HA&CS for 17 days”.
Figure 7. Violin-box-plot of epithelial cells, pH, red blood cells and white blood cells according to time in “non-infected without HA&CS + infected without HA&CS” vs. “non-infected with HA&CS for 17 days + infected with HA&CS for 17 days”.
Cancers 17 03154 g007
Table 1. Temporal assessment of urine parameters in non-infected patients without HA&CS and treated with low dose of 131I versus non-infected patients without HA&CS and treated with high dose of 131I.
Table 1. Temporal assessment of urine parameters in non-infected patients without HA&CS and treated with low dose of 131I versus non-infected patients without HA&CS and treated with high dose of 131I.
ParameterA1
Non-Infected Without HA&CS Low Dose 131I		A2
Non-Infected Without HA&CS High Dose 131I		p (A1 vs. A2)
Baseline
Mean ± SD
(95%CI)		Second Day Mean ± SD
(95%CI)		Seventh Day Mean ± SD
(95%CI)		Baseline
Mean ± SD
(95%CI)		Second Day Mean ± SD
(95%CI)		Seventh Day Mean ± SD
(95%CI)
Bacteria (count)1.00 ± 0.00
(NA to NA)		1.27 ± 0.55
(1.03 to 1.52)		1.27 ± 0.63
(0.99 to 1.55)		1.00 ± 0.00
(NA to NA)		1.34 ± 0.81
(1.04 to 1.65)		1.28 ± 0.80
(0.97 to 1.58)		0.81
Epithelial Cells (count/mL)10.27 ± 9.02
(6.27 to 13.38)		20.23 ± 21.59
(10.65 to 29.80)		11.18 ± 15.56
(4.28 to 18.08)		10.38 ± 12.21
(5.73 to 15.02)		16.83 ± 20.47
(9.04 to 24.62)		13.76 ± 19.93
(6.18 to 21.34)		0.95
pH5.80 ± 0.50
(5.57 to 6.02)		6.07 ± 0.58
(5.81 to 6.33)		6.14 ± 0.85
(5.76 to 6.51)		5.72 ± 0.56
(5.51 to 5.94)		5.90 ± 0.52
(5.70 to 6.10)		6.14 ± 0.85
(5.81 to 6.46)		0.57
Red Blood Cells (count/mL)9.68 ± 9.51
(5.47 to 13.9)		12.45 ± 16.15
(5.30 to 19.61)		15.09 ± 18.28
(6.99 to 23.19)		6.79 ± 6.2
(4.43 to 9.15)		9.66 ± 7.21
(6.91 to 12.40)		11.55 ± 10.41
(7.59 to 15.51)		0.21
White Blood Cells (count/mL)12.86 ± 17.88
(4.94 to 20.79)		16.86 ± 18.46
(8.68 to 25.05)		20.36 ± 37.29
(3.83 to 36.90)		8.29 ± 6.85
(5.63 to 10.94)		25.18 ± 26.71
(14.82 to 35.54)		21.93 ± 32.47
(9.34 to 34.52)		0.71
Bacteria: Baseline vs. Baseline, p = 0.99; Second Day vs. Second Day, p = 0.72; Seventh Day vs. Seventh Day, p = 0.99. Epithelial Cells: Baseline vs. Baseline, p = 0.97; Second Day vs. Second Day, p = 0.61; Seventh Day vs. Seventh Day, p = 0.95. pH: Baseline vs. Baseline, p = 0.66; Second Day vs. Second Day, p = 0.31; Seventh Day vs. Seventh Day, p = 0.99. Red Blood Cells: Baseline vs. Baseline, p = 0.25; Second Day vs. Second Day, p = 0.48; Seventh Day vs. Seventh Day, p = 0.45. White Blood Cells: Baseline vs. Baseline, p = 0.29; Second Day vs. Second Day, p = 0.23; Seventh Day vs. Seventh Day, p = 0.88.
Table 2. Assessment of urine parameters in non-infected patients without HA&CS pre-treatment.
Table 2. Assessment of urine parameters in non-infected patients without HA&CS pre-treatment.
ParameterHypothyroidism (n = 16)
Mean ± SD, (95%CI)		rhTSH (n = 35)
Mean ± SD, (95%CI)		p
Bacteria (count)1.00 ± 0.00, (NE to NE)1.00 ± 0.00, (NE to NE)--
Epithelial cells (count/mL)11.50 ± 7.77, (7.36 to 15.64)9.80 ± 12.06, (5.66 to 13.94)0.61
pH5.87 ± 0.53, (5.59 to 6.16)5.70 ± 0.53, (5.52 to 5.88)0.28
Red Blood Cells (count/mL)10.37 ± 11.52, (4.23 to 16.51)6.97 ± 5.32, (5.14 to 8.80)0.27
White Blood Cells (count/mL)8.56 ± 9.89, (3.29 to 13.83)11.12 ± 14.25, (6.14 to 16.09)0.52
Table 3. Assessment of urine parameters in infected patients without HA&CS pre-treatment.
Table 3. Assessment of urine parameters in infected patients without HA&CS pre-treatment.
ParameterHypothyroidism (n = 5)
Mean ± SD, (95%CI)		rhTSH (n = 10)
Mean ± SD, (95%CI)		p
Bacteria (count)2.40 ± 0.55, (1.72 to 3.08)2.50 ± 0.53, (2.12 to 2.88)0.74
Epithelial cells (count/mL)85.40 ± 6.19, (77.72 to 93.08)62.50 ± 31.97, (39.63 to 85.37)0.053
pH5.70 ± 0.27, (5.36 to 6.04)5.70 ± 0.48, (5.35 to 6.04)1.00
Red Blood Cells (count/mL)30.60 ± 7.02, (21.88 to 39.32)28.30 ± 28.92, (7.61 to 48.99)0.82
White Blood Cells (count/mL)30.40 ± 12.93, (14.34 to 46.46)30.70 ± 27.21, (11.23 to 50.17)0.98
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MDPI and ACS Style

Campagna, G.; Lauri, C.; Lanzolla, T.; Festa, A.; Carideo, L.; Signore, A. Role of Hyaluronic Acid and Chondroitin Sulphate in Protecting Urinary Epithelium in Patients Operated for Differentiated Thyroid Cancer Undergoing Ablation Therapy with Iodine-131. Cancers 2025, 17, 3154. https://doi.org/10.3390/cancers17193154

AMA Style

Campagna G, Lauri C, Lanzolla T, Festa A, Carideo L, Signore A. Role of Hyaluronic Acid and Chondroitin Sulphate in Protecting Urinary Epithelium in Patients Operated for Differentiated Thyroid Cancer Undergoing Ablation Therapy with Iodine-131. Cancers. 2025; 17(19):3154. https://doi.org/10.3390/cancers17193154

Chicago/Turabian Style

Campagna, Giuseppe, Chiara Lauri, Tiziana Lanzolla, Anna Festa, Luciano Carideo, and Alberto Signore. 2025. "Role of Hyaluronic Acid and Chondroitin Sulphate in Protecting Urinary Epithelium in Patients Operated for Differentiated Thyroid Cancer Undergoing Ablation Therapy with Iodine-131" Cancers 17, no. 19: 3154. https://doi.org/10.3390/cancers17193154

APA Style

Campagna, G., Lauri, C., Lanzolla, T., Festa, A., Carideo, L., & Signore, A. (2025). Role of Hyaluronic Acid and Chondroitin Sulphate in Protecting Urinary Epithelium in Patients Operated for Differentiated Thyroid Cancer Undergoing Ablation Therapy with Iodine-131. Cancers, 17(19), 3154. https://doi.org/10.3390/cancers17193154

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