Clearing The Radioactive Iodine From Your Body
Some of the radioactive iodine will be taken up by your thyroid cells, but there will be some left over. Most of the extra radioactive iodine will leave your body through your urine , and smaller amounts will leave your body in your saliva , sweat, and bowel movements .
Follow these guidelines to help the radioactive iodine leave your body quickly.
- Drink lots of liquids. Starting right after your treatment, try to drink at least 1 cup of low-iodine liquid every hour while youre awake. Keep doing this for 2 to 3 days after your treatment. You dont have to wake up at night to drink liquids.
- Your urine will be radioactive so urinate as much as you can to empty your bladder. Try not to get urine outside of the toilet. If you do get urine outside of the toilet, wear gloves and clean up it up with an all-purpose cleaning disinfectant. If you normally stand while urinating, sit for 2 days after your treatment unless your healthcare provider gives you other instructions. This is so you can avoid getting urine anywhere but the toilet. Try to urinate every time you feel the urge instead of holding it in your bladder.
- Your bowel movements will also be radioactive. Go to the bathroom as much as you can so your bowel movements dont stay in your colon.
- If youre often constipated , ask your doctor about taking laxatives before your treatment. If you dont have a bowel movement within 24 hours after your treatment, call your doctor.
Maximizing The Effectiveness Of Radioactive Iodine Therapy
Radioactive iodine therapy for thyroid cancer is most effective in people who have high levels of thyroid-stimulating hormone, or TSH. This hormone is produced by the pituitary gland, which is located at the base of the brain and produces many hormones. TSH tells the thyroid to absorb iodine, which is then converted to thyroxine. The thyroids ability to absorb iodine is important for the success of radioactive iodine therapy.
If youve had surgery to remove part or all of the thyroid, your doctor may wait a few weeks before prescribing a replacement thyroid hormone. During that time, you experience whats known as thyroid hormone withdrawal, which makes the pituitary excrete more TSH. Excess thyroid-stimulating hormone is necessary for the success of radioactive iodine therapy.
Another way your doctor may try to increase the effectiveness of radioactive iodine therapy is to give you an injection of a medication called recombinant human thyroid hormonethyroid-stimulating hormone made in a laboratory. This injection is given for two days before radioactive iodine therapy begins. The medication elevates thyroid-stimulating hormone levels enough to make the radioactive iodine therapy as effective as thyroid hormone withdrawal.
When radioactive iodine therapy is being considered for thyroid cancer, the body must be depleted of inorganic iodine, so the levels of thyroid-stimulating hormone increase, helping with the effectiveness of radioactive iodine therapy.
What Is Thyroid Disease
Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired it can make your heart beat faster, cause you to lose weight without trying and even make you feel nervous. On the flip-side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.
These two main disorders can be caused by a variety of conditions. They can also be passed down through families .
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Side Effects Of Rai Treatment
All medical treatments have side effects RAI is no different. In previous years, the goal of therapy was to get rid of all thyroid cancer cells no matter the total dose of RAI. With increased awareness of the potential risks associated with RAI, the current approach attempts to more carefully balance the risks and benefits of treatment.
RAI therapy is associated with short- and long-term medical risks, including:
The Pediatric Thyroid Center at CHOP is committed to determining which patients will or will not benefit from RAI therapy. You, the patient and family, are important members of the treatment team. Be informed and be involved. Know the risks and the benefits of the treatment being recommended and the expertise of the center providing your care. The potential risks of complications decrease if you receive care in a center dedicated to the care of pediatric patients with thyroid disease.
How Long Does It Take To Recover From Thyroid Surgery
It will take your body a few weeks to recover after your thyroid is surgically removed . During this time you should avoid a few things, including:
- Submerging your incision under water.
- Lifting an object thats heavier than 15 pounds.
- Doing more than light exercise.
This generally lasts for about two weeks. After that, you can return to your normal activities.
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Preparing For Radioactive Iodine Treatment For Thyroid Cancer
Radioactive iodine treatment is a type of internal radiotherapy. It uses a radioactive form of iodine called iodine 131 . It is a useful treatment in thyroid cancer because the thyroid gland absorbs and stores most of the iodine in your body. The thyroid gland gets iodine from certain foods and uses this to make essential thyroid hormones.
Radioactive iodine is a targeted treatment. The radioactive iodine circulates throughout your body in your bloodstream. But it is mainly taken up by thyroid cells, having little effect on other cells. Thyroid cancer cells in your body pick up the iodine. The radiation in the iodine then kills the cancer cells.
It is only suitable for some types of thyroid cancer. It is a treatment for:
- follicular thyroid cancer
- papillary thyroid cancer
It can treat the cancer even if it has spread. But even if you have one of these types of thyroid cancer, this treatment may not be necessary or suitable for you. Not all of the cancer cells take up the iodine so you may have a test dose to see if they do.
Papillary Cancer And Its Variants
Most cancers are treated with removal of the thyroid gland , although small tumors that have not spread outside the thyroid gland may be treated by just removing the side of the thyroid containing the tumor . If lymph nodes are enlarged or show signs of cancer spread, they will be removed as well.
In addition, recent studies have suggested that people with micro-papillary cancers may safely choose to be watched closely with routine ultrasounds rather than have immediate surgery.
Even if the lymph nodes arent enlarged, some doctors recommend central compartment neck dissection along with removal of the thyroid. Although this operation has not been shown to improve cancer survival, it might lower the risk of cancer coming back in the neck area. Because removing the lymph nodes allows them to be checked for cancer, this surgery also makes it easier to accurately stage the cancer. If cancer has spread to other neck lymph nodes, a modified radical neck dissection is often done.
Treatment after surgery depends on the stage of the cancer:
People who have had a thyroidectomy will need to take daily thyroid hormone pills. If RAI treatment is planned, the start of thyroid hormone therapy may be delayed until the treatment is finished .
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Is There Any Special Preparation Needed For The Procedure
You should not eat or drink after midnight on the day of the procedure. If you have been taking anti-thyroid medications, you must stop at least three days before the therapy is given. Frequently, the anti-thyroid medication is stopped for five to seven days before therapy.
You will be able to return home following radioactive iodine treatment, but you should avoid prolonged, close contact with other people for several days, particularly pregnant women and small children. The majority of the radioactive iodine that has not been absorbed leaves the body during the first two days following the treatment, primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces.
If your work or daily activities involve prolonged contact with small children or pregnant women, you will want to wait several days after your treatment to resume these activities. Patients with infants at home should arrange for care to be provided by another person for the first several days after treatment. Your radiologist can be more specific for your given situation, but usually this time period is only two to five days.
Your treatment team will give you a list of other precautions to take following your treatment with I-131. The following guidelines comply with the Nuclear Regulatory Commission:
Women who have not yet reached menopause should fully discuss the use of I-131 with their physician.
Getting Radioactive Iodine Therapy
Usually you will be given a small pill. The radioiodine goes into your bloodstream and travels to thyroid cells in your body. The thyroid cells absorb the radioiodine and it kills them.
Other cells in your body will not be harmed as they do not absorb the radioiodine. The treatment can be repeated if thyroid cells are still present.
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Having Your Radioactive Iodine Treatment
You are usually admitted to the ward on the day of your RAI treatment. You usually have radioactive iodine as a capsule. Before and after the treatment, you can eat normally. Your nurse will encourage you to drink plenty of fluids.
Because the iodine is radioactive, you will be radioactive for a while after the treatment. The radioactivity will slowly leave your body in your:
Radioiodine And Risk Of Malignancy
The link between external head and neck irradiation and increased rate of thyroid carcinomas dramatically shown by the Chernobyl disaster of 1986 , has naturally raised concerns of possible carcinogenic effects of RAI as a source of ionising radiation. Although there are case reports suggesting a link, large epidemiologic studies revealed no association between RAI for GD and subsequent development of thyroid carcinoma .
The Cooperative Thyrotoxicosis Follow-up Study did demonstrate an excess risk of death from thyroid carcinoma in patients with RAI treated toxic Multi-nodular goitre . This association raises the consideration of genetic predisposition of those with MNG to thyroid cancer as in those with familial PTC have increased familial incidence of thyroid nodules and MNG .
There is no evidence for increased mortality from any other forms of cancer , including leukaemia . A recent cohort study showed increased mortality from cancer after RAI for hyperthyroidism, with an increased risk of death in patients older than 60 years at treatment. Mortality rose with the amount of RAI given and in those with nodular thyroid disease. There was also a suggestion of increased upper GI cancer in elderly males, but this observation has not been confirmed by other studies.
5. Follow Up of Patients who have received RAI
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What Is The Thyroid
The thyroid gland is a small organ thats located in the front of the neck, wrapped around the windpipe . Its shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body.
When your thyroid doesnt work properly, it can impact your entire body. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, its called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.
Preparing For Radioactive Iodine Therapy
High TSH level
You will need a high level of thyroid-stimulating hormone in your bloodstream for the treatment to be a success. This hormone activates thyroid cells and encourages them to absorb the radioactive iodine. The level of TSH can be raised by:
- Taking recombinant TSH: Recombinant human TSH boosts the level of TSH in your body to make sure the radioactive iodine therapy works. It is given as two injections into your buttocks over 2 days before the iodine capsule is taken.
- Stopping hormone therapy: Your doctor might ask you to stop taking your hormone replacement tablets about 46 weeks before the therapy. This is because these hormones stop TSH from being made. Stopping the hormone therapy can make you feel more tired, but this will ease once the medication is resumed. Usually only a small number of patients are asked to stop taking their hormone therapy.
If theres less iodine in your body it will be more willing to take up the radioactive iodine, so you may be told to limit the iodine in your diet for 2 weeks before your treatment. Your nurse will tell you what foods to avoid.
Pregnancy and breastfeeding
Use a reliable method of contraception before you start treatment its important not to become pregnant or father a child during treatment and for a few months afterwards. Ask your doctor about this. Tell your doctor if theres a chance you might be pregnant. Radioiodine treatment can harm the baby and so isnt suitable for pregnant women.
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Preparation Of A Papillary Thyroid Cancer Patient For Radioactive Iodine Treatment
Papillary thyroid cancer patients must be taken off of levothyroxine thyroid hormone for a minimum of four weeks, taken off of liothyrionine thyroid hormone for a minimum of two weeks, or receive a medication which is TSH . Additionally, papillary thyroid cancer patients must be on a low iodine diet for a minimum of four weeks to starve their body of iodine. Those patients which have undergone CAT scans with intravenous contrast must wait until their blood iodine levels have been adequately decreased . Note, a desire to treat with radioactive iodine should never prevent the use of necessary CAT scans for the evaluation of a papillary thyroid cancer patient.
The potential risks of RAI treatment include:
- Dry mouth and or eyes
- Narrowing of the drainage duct of the eyes tears leading to excessive tearing down the cheek
- Swelling in your cheeks from inflammation or damage to the saliva producing glands
- Short term changes to taste and smell
- Lowered testosterone levels in males
- Change in periods in women
- Second tumors
How Is Iodine Deficiency Treated
Iodine levels can be measured in the blood or the urine. However, these tests are not good at accurately determining how much iodine is in your body and so cannot be used to diagnose iodine deficiency. When iodine deficiency is seen in an entire population, it is best managed by ensuring that common foods that people eat contain sufficient levels of iodine. Since even mild deficiency during pregnancy can have effects on a pregnancy and the developing baby, all U.S. women who are planning pregnancy, pregnant, or breastfeeding should take a multivitamin containing 150 g iodine per day.
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Side Effects And Risks
RAI treatment may cause a dry mouth, so suck on sour hard candies or chew gum to stimulate your salivary glands. It may also dry up tears, so your doctor may suggest not wearing contact lenses for a while. Drink lots of water to flush out the radioactivity.
Other side effects may include:
- Changes in taste or loss of taste
- Sore neck and swelling
How Is Iodine Deficiency Prevented
As with many diseases, it is better to prevent the problem rather than have to treat it. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Elimination of iodine deficiency has been a major goal of the Iodine Global Network, UNICEF, and the World Health Organization. Iodized salt has been the mainstay of the prevention of iodine deficiency worldwide. In regions where iodized salt is not widely available, or where pregnant women are known to have inadequate iodine intakes, use of a daily iodine-containing supplement may be recommended for pregnant and breastfeeding women. Injections of iodized oil are occasionally used in severely iodine deficient regions of the world where widespread iodized salt use is not possible.
UNITED STATES RECOMMENDATIONS The Institute of Medicine has set the Recommended Dietary Allowance for iodine in adult men and women at 150 g per day. Individuals who add salt to their food regularly during cooking or at the table should use iodized salt. In the US and Canada, one teaspoon of iodized salt contains approximately 250 g iodine. Most U.S. iodine-containing multivitamins marketed for non-pregnant adults have at least 150 g iodine, but only about 60% of the types of prenatal multivitamins in the U.S. contain iodine.
Does Rai For Thyroid Imaging Provide The Best Results
I-123 is the usual isotope used to take pictures and determine the activity of the intact thyroid gland , since it is harmless to thyroid cells. No special radiation precautions are necessary after a thyroid scan or RAIU using I-123. I-131 can also be used to take pictures of the thyroid gland, although it is rarely used due to the harmful effects it has on thyroid cells.
What Is The Optimal Dose Of Rai
In a study comparing treatment with two single fixed first doses of RAI of 185 MBq and 370 MBq, cure after RAI , was achieved in 85% of patients who received 370 MBq and 70% in the lower dose group. In addition, the second dose was administered to 30% of the lower dose group compared to only 15% of the higher dose group. The incidence of hypothyroidism at 1 year was 71.4% in the high dose group and 66.4% in the low dose group who required a second dose of RAI. The advantages of lower hypothyroid rates were lost if a second dose was administered. The authors concluded that a single fixed dose of 370 MBq is highly effective. Similar findings were noted from a study of 605 patients who were given various doses of RAI . Eighty-seven percent of those who were given 370 MBq were either hypo- or euthyroid.
Other authors argue that a larger fixed dose will minimise the need for re-treatment, and the morbidity and costs of the ineffective primary treatment. This approach uses high doses of RAI to deliver a dose of approximately 8 MCi to the thyroid at 24 hours. This requires a dose of 15 MCi to be given . Cure rates were 86% at 1 year. Similarly, Kendal-Taylor et al. used 555 MBq as a fixed dose and demonstrated that 64% of their patients were hypothyroid and 30% were euthyroid 1 year after therapy.
2. Considerations before RAI therapy
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