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What Is Radioactive Iodine Treatment For Thyroid Cancer

Radioactive Iodine For Hyperthyroidism

Radioactive Iodine Therapy | Thyroid Cancer Update

Radioiodine, or RAI, is given as a pill, to treat hyperthyroidism by gradually shrinking your thyroidultimately destroying the gland. Yes, RAI is the same as radioactive iodine threapy, which was the formal medical term. It has been changed to lessen the scariness of sound of this therapy.

This thyroid treatment is much safer than it sounds in fact, it is the most commonly used hyperthyroid treatment in the US. Unlike antithyroid medications, radioactive iodine is a permanent and more reliable cure for hyperthyroidism.

Radioiodine Ablation Radioactive iodine therapy can destroy all or part of the thyroid gland, depending on need. While there may be instances when you won’t need to have the entire thyroid gland rendered nonfunctional to alleviate your hyperthyroid symptoms, total destruction of the thyroid is most often necessary.

Your doctor may refer to it as radioactive iodine ablation . This article will focus on what you might expect when you are faced with the total elimination of your thyroid gland and its key functions.

Graves disease, the most common form of hyperthyroidism, occurs most often in women, is treated with radioactive iodine, given as a pill. Photo: 123rf

In determining the best dose, the size of the thyroid gland and results of the uptake test are the two most important factors. The larger the gland, the larger the radioactive iodine dose. The higher the iodine uptake, the smaller the dose.

Risks And Side Effects

Your body will give off radiation for some time after you get RAI therapy. Depending on the dose of radioiodine used and where you are being treated, you might need to be in the hospital for a few days after treatment, staying in a special isolation room to prevent others from being exposed to radiation. Some people may not need to be hospitalized. Once you are allowed to go home after treatment, you will be given instructions on how to protect others from radiation exposure and how long you need to take these precautions. These instructions may vary slightly by treatment center. Be sure you understand the instructions before you leave the hospital.

Short-term side effects of RAI treatment may include:

Chewing gum or sucking on hard candy may help with salivary gland problems.

Radioiodine treatment also reduces tear formation in some people, leading to dry eyes. If you wear contact lenses, ask your doctor how long you should keep them out.

Men who receive large total doses of radiation because of many treatments with RAI may have lower sperm counts or, rarely, become infertile. Radioactive iodine may also affect a womans ovaries, and some women may have irregular periods for up to a year after treatment. Many doctors recommend that women avoid becoming pregnant for 6 months to a year after treatment. No ill effects have been noted in the children born to parents who received radioactive iodine in the past.

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:

  • urine

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Pregnancy And Radioactive Iodine Therapy

Dont get pregnant or get your partner pregnant for at least 6 months after getting radioactive iodine therapy, or as long as your doctor tells you to. Use birth control after treatment for at least 6 months after getting this treatment. If youre planning to have a child, talk with your doctor about your plans before your treatment.

What Happens During Radiation Treatment

Radioactive iodine treatment instructions (for thyroid ...

Two types of radiation are used for thyroid cancer patients.

During I-131 treatment: You will swallow a capsule or pill that contains radioactive iodine . Both healthy and cancerous thyroid cells absorb the I-131, which destroys them. This treatment is usually given in a hospital. You may stay overnight. During the treatment and for a short period after, you will give off radiation. Your doctor will tell you how to protect your family, friends and pets at home. See the Radioactive Iodine Therapy page for more information.

External Beam Therapy : EBT begins with treatment planning using either x-rays or a computed tomography scan. These exams help plan the type and direction of radiation beams to treat the cancer. Each treatment will last a few minutes each day, although it may take longer to get you set up. Once the radiation starts, you will hear some electrical noise and see warning lights from the machine. Patients do not feel the radiation during treatment.

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Welcome To Houston Thyroid & Endocrine Specialists

Dr. Jogi , Dr. Desai , Dr. Dumitru, Dr. Mehwish Ismaily, Dr. Kriti Gupta, and Dr. Elhaj welcome patients from all over Texas, as well as other states and counties. We only have two offices, located in the Texas Medical Center and in Katy at the Memorial Hermann Hospital, Professional Building 1. Learn more from the board certified endocrinologists at Houston Thyroid and Endocrine Specialists.

How Can I Choose From Among The Options

In addition to talking with family and friends, you will need a team of doctors to help advise you. This team may include a surgeon, a radiologist, a radiation oncologist, a medical oncologist and an endocrinologist, a doctor who specializes in diseases of the glands. A radiation oncologist treats cancer with radiation. A medical oncologist treats cancer with drugs. You and your care team will create a treatment plan that works best for your cancer.

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Diagnosis Of Thyroid Cancer

Usually, diagnosing thyroid cancer begins when a routine test suggests a problem with the thyroid. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for cancer or other health problems.

The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as thyroid cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of thyroid cancer.

The following tests are commonly used to rule out or diagnose thyroid cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.

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Adverse Effects Of Radioactive Iodine

Radioactive Iodine Treatment for Thyroid Cancer

Overall, RAI is a fairly safe and effective âtargeted therapyâ in selected patients. A list of potential adverse effects of RAI treatment that should be discussed with patients are listed in .

Reduced sperm counts
Secondary malignancy

Xerostomia is one of the most common adverse effects of RAI therapy and is directly correlated with administered activity and cumulative dose. A recent combination of questionnaire-based studies assessed consecutive patients receiving 100 mCi 131I over a 2-year period . Questionnaires were sent to 800 patients 1 year after treatment and again approximately 7 years after RAI. Twenty-seven percent of patients had salivary gland discomfort or swelling at the early time point, which persisted in 14% of patients at the late time point. Xerostomia was seen in 39% of patients at the early time point and persisted in 32% of patients at the late time point. Responses were limited , and it is likely that many patients with no symptoms did not respond. Nevertheless, at least 6â7% of the 800 patients treated noted persistent long-term symptoms of xerostomia. Also, all patients were treated starting at 4 h after RAI therapy with lemon juice three times daily. The ATA guidelines found evidence lacking to recommend for or against the use of routine agents like lemon juice to prevent salivary gland damage after RAI therapy . Limiting the administered activity of RAI and hydration are likely the best measures to prevent salivary gland damage.

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If Treatment Does Not Work

Recovery from thyroid cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

After Radioactive Iodine Treatment For Thyroid Cancer

Having radioactive iodine treatment means you will be radioactive for several days afterwards. You will be able to go home from hospital when the radiation level in your body is at a safe level. As you will still have some radioactivity in your body you may still have to take some precautions when you go home. Your healthcare team will explain everything to you.

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Radioactive Iodine Therapy For Thyroid Cancer

Your thyroid gland absorbs nearly all of the iodine in your body. Because of this, radioactive iodine can be used to treat thyroid cancer. The RAI collects mainly in thyroid cells, where the radiation can destroy the thyroid gland and any other thyroid cells that take up iodine, with little effect on the rest of your body. The radiation dose used here is much stronger than the one used in radioiodine scans, which are described in Tests for Thyroid Cancer.

This treatment can be used to ablate any thyroid tissue not removed by surgery or to treat some types of thyroid cancer that have spread to lymph nodes and other parts of the body.

Radioactive iodine therapy helps people live longer if they have papillary or follicular thyroid cancer that has spread to the neck or other body parts, and it is now standard practice in such cases. But the benefits of RAI therapy are less clear for people with small cancers of the thyroid gland that do not seem to have spread, which can often be removed completely with surgery. Discuss your risks and benefits of RAI therapy with your doctor. Radioactive iodine therapy cannot be used to treat anaplastic and medullary thyroid carcinomas because these types of cancer do not take up iodine.

Discuss Your Treatment Plan

Iodine Deficient Diet preparing for Radioactive iodine ...

Your doctor will discuss your treatment plan with you.

Your treatment plan will follow these steps that will take place over a few days:

1. On the first day, youll have blood tests. After those tests, youll see your doctor and get a thyrotropin alfa injection to help you get ready for your treatment. This injection will help any leftover thyroid tissue absorb the radioactive iodine.

2. On the second day, youll get another thyrotropin alfa injection. Then youll get a small diagnostic dose of radioactive iodine in a pill. You wont have to follow any precautions after getting this small diagnostic dose of radioactive iodine. After you take this pill, youll have a whole-body scan. This scan will show your doctor how the radioactive iodine is being taken up in your body.

3. On the third day, youll have your full dose of radioactive iodine treatment. This is an outpatient procedure, so you wont be admitted to the hospital.

4. Youll have another whole-body scan several days after your treatment. This helps your doctor see where the dose of radioactive iodine was taken up in your body.

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How Does Radioactive Iodine Treat Thyroid Cancer

The most common types of thyroid cancer can usually be treated with large doses of radioactive iodine. The therapy is usually given after removal of the thyroid gland to destroy any remaining thyroid tissue.

A tracer dose of radioactive iodine can also be used to track remaining thyroid tissue and/or cancer that could have spread to other parts of the body. These tests show if iodine concentrates in areas that contain thyroid cancer, and whether large amounts of RAI are needed to destroy the tumor implants.

Treatment Options By Stage

Almost all thyroid cancers are treated with surgery. If the thyroid cancer is only within the tissues of the neck, both in the thyroid gland and in the lymph nodes, surgery will typically be the first treatment. Patients with later-stage disease may be treated with surgery as well, but other treatments may be done first. Clinical trials may be recommended at any stage as a treatment option.

Hormone therapy and radioactive iodine therapy are only given for papillary, follicular, and Hurthle cell thyroid cancers. MTC and anaplastic thyroid cancers are not managed with radioactive iodine thyroid or thyroid hormone therapy.

Stage I: Surgery, hormone therapy, possible radioactive iodine therapy after surgery

Stage II: Surgery, hormone therapy, possible radioactive iodine therapy after surgery

Stage III: Surgery, hormone therapy, possible radioactive iodine therapy or external-beam radiation therapy after surgery

Stage IV: Surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. See below for more information, for Metastatic thyroid cancer.

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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 Can I Prepare For Rai

Radioactive Iodine Treatment of Thyroid Cancer and Risk of Myelodysplastic Syndromes

One way to maximize the effects of RAI is by raising your TSH level. There are 2 ways to do this:

  • Stop hormone replacement
  • Receive Thyrogen®
  • For either, it is also recommended that you go on a Low Iodine Diet.

    Because you are receiving a radioactive substance, there are some precautions you should be aware of. The resources below can help you prepare:

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    What Are The Side Effects Of Radioactive Iodine

    Permanent hypothyroidism is an expected side effect of RAI treatment for hyperthyroidism. Fortunately, hypothyroidism is much easier to treat than hyperthyroidism using hormone replacement therapy. This is a lifelong treatment that is safe, reliable and inexpensive.

    Temporary side effects of RAI may include:

    • Neck tenderness and swelling.
    • Excessive tearing from the eyes.

    Are There Long Term Risks Of I

    In general, RAI is a safe and effective treatment for the thyroid disorders mentioned above. Hypothyroidism is a common side effect of RAI for hyperthyroidism and always seen after RAI for thyroid cancer. This is usually easily treated with thyroid hormone replacement . Some studies suggest a slight increase in thyroid cancers may be seen after RAI treatment for hyperthyroidism. Loss of taste and dry mouth due to salivary gland damage may be seen. The use of lemon drops, vitamin C or sour stimulation to potentially decrease the exposure of the salivary glands to RAI is controversial and should be discussed with your physician. Importantly, once you have been treated with RAI, regular medical follow-up is lifelong.

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    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.

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