Radioactive Iodine Treatment Basics

Radioactive iodine, given in a liquid form or pill, is absorbed and concentrated by the thyroid gland which is the only organ in your body with cells that actually absorbs iodine. The treatment destroys thyroid tissue but does not harm other tissue in the body.

*While radiation exposure can cause thyroid cancer, treatment of hyperthyroidism with radioactive iodine does not increase your chances of getting thyroid cancer.

Why Radioactive Iodine

Radioactive iodine is used after surgical removal of the thyroid gland (thyroidectomy) because of thyroid cancer. Radioactive iodine therapy destroys any remaining thyroid tissue or cancer cells that were not removed during surgery. Radioactive iodine may also be used to treat hyperthyroidism in people who have noncancerous (benign) thyroid nodules that make too much thyroid hormone.

What to Expect After Treatment

• Within days, the radioactive iodine passes out of your body in your urine.

• To avoid exposing other people to radioactivity, it is important to do the following for the first one week after your radioactive iodine treatment:

• Drink plenty of fluids –an eight ounce glass of water every couple of hours is ideal  to help flush the radiation out of your body.

• Avoid children, pregnant women and pets for a minimum of one week.

• Remain a minimum of 3 feet away from people at all times for at least one week.

• Do not sit next to someone in a motor vehicle for more than 1 hour for one week.

• Avoid kissing or sexual intercourse for a minimum of one week.

• Do not sleep with your spouse or anyone else in your own room for one week (if you have small children it is best to stay in a hotel the first few days).

• Use separate (or disposable) eating utensils for the first one week after treatment, wash them or dispose of them separately.

• Use separate towels, washcloths, and sheets. Wash these items and all your personal clothing separately for one week. (Ideally keep get rid of them).

• Wash your hands with soap and lots of water frequently, specially each time you use the toilet and before touching any cooking utensils.

• Keep the toilet very clean: flush the toilet 2 or 3 times after each use. Men should urinate sitting down to avoid splashing for one week.

• Rinse the bathroom sink and tub thoroughly 2 or 3 times after using them for one week.

How Well It Works

In almost all cases, your thyroid hormone levels will return to normal or below normal after radioactive iodine treatment. This may take 8 to 12 weeks or longer. If your thyroid hormone level does not go down after 6 months, you may need another dose of radioactive iodine.

If you have thyroid cancer and you are treated with radioactive iodine, it may take from several weeks to many months for your body to get rid of any remaining cancer cells.

Your thyroid nodule is unlikely to grow after being treated with radioactive iodine.

Common Side Effects

• The risks from radioactive iodine treatment include:
• Metallic taste in your mouth.
• Dry mouth.
• Sore throat.
• Neck pain. Radioactive iodine treatment can make your neck swell up or hurt.
• Nausea or vomiting, which is usually mild.
• Constipation or diarrhea.
• Extreme fatigue.
• Unusually low (hypothyroidism) or unusually high (hyperthyroidism) thyroid levels.

Important Risk Factors To Think About

If you are pregnant, you should not receive radioactive iodine treatment. This kind of treatment can damage your fetus's thyroid gland or expose your fetus to radioactivity. For this reason it is very important to stay away from pregnant women after radioactive iodine treatment.

You should NOT breast-feed your baby after you have been treated with radioactive iodine. Ask your doctor when it will be safe to breast-feed.

Different people with thyroid cancer will receive different doses of radioactive iodine. If you are young and you do not have a great risk of your cancer coming back, you will probably need less radioactive iodine than an older person. Sometimes this means that a younger person who receives radioactive iodine treatment will not have to stay overnight in a hospital.

If you have had radioactive iodine treatment and you want to travel 3 to 4 days after treatment, it is important to prepare for any problems you may have at airport security. People who have had radioactive iodine treatment can set off the radiation detection machines in airports and other public/government buildings. If you plan to travel by airplane within 3 or 4 days after your treatment, check with local authorities about any steps or permission you may need to travel.

A special low iodine diet  must be followed prior to radioactive iodine treatment so that it can be effective. Sometimes antithyroid medication such as Thyrogen are used before radioactive iodine to treat a noncancerous nodule that is making too much thyroid hormone and causing hyperthyroidism.

MEDICAL REVIEW 02/28/2012

Thyroid Cancer Treatment: What About Chemotherapy?

Thyroid cancer is unique among cancers. In fact, thyroid cells are unique among all cells of the human body. They are the only cells that have the ability to absorb iodine. Iodine is required for thyroid cells to produce thyroid hormone, so they absorb it out of the bloodstream and concentrate it inside the cell.

Most thyroid cancer cells retain this ability to absorb and concentrate iodine. This provides a perfect "chemotherapy" strategy. Radioactive Iodine is given to the patient with thyroid cancer after their cancer has been removed. If there are any normal thyroid cells or thyroid cancer cells remain in the patient's body (and any thyroid cancer cells retaining this ability to absorb iodine), then these cells will absorb and concentrate the radioactive "poisonous" iodine. Since all other cells of our bodies cannot absorb the toxic iodine, they are unharmed. The thyroid cancer cells, however, will concentrate the poison within themselves and the radioactivity destroys the cell from within. Patients undergoing radio-active iodine therapy are "lucky": no typical chemo sickness, no hair loss, no nausea, no diarrhea and in most cases no pain. 

Most, but not all, patients with papillary and follicular thyroid cancer need radioactive iodine treatments after their surgery. This is important to know. Almost all, however, should have the iodine treatment if a cure is to be expected. Patients with medullary cancer of the thyroid usually do not need iodine therapy because medullary cancers almost never absorb the radioactive iodine. Some small papillary cancers treated with a total thyroidectomy may not need iodine therapy as well, but for a different reason.

These cancers (medullary and some small papillary cancers) are often cured with simple (complete) surgical therapy alone. This varies from patient to patient and from cancer to cancer. This decision will be made between the surgeon, the patient, and the referring endocrinologist or internist. Remember, radioactive iodine therapy is considered a safe treatment. If you need it, take it.

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Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Demonstration of Radioactivity from Thyroid Cancer Treatment

Q: What do you do when you are 1) a nerd, 2) just received a high dose of a radioactive substance in your body, and 3) have nothing else to do because you can hardly concentrate?

A: You make a teaching video illustrating radiation.

The really interesting thing is that the dose of Iodine was actually 1.2 micrograms which equates to 5.5 billion radiation particles per second. A teaspoon of table salt contains this much non-radioactive Iodine!

Useful Tips After Thyroidectomy & RAI Treatment

My Paper Plate Setting 

In the past decade there is a growing "Go Green" movement and of course we  are all about going “green” but during and after thyroid cancer surgery and treatment might not be the time. If you live alone, paper plates and plastic cups,  bowls and utensils are essential. You won’t be in the mood to do the dishes and looking at dirty dishes will only make you moody!   


If like most thyroid cancer patients you must undergo radioactive iodine therapy then you must make sure you get rid of anything you use -that may be used by other (i.e. kitchen utensils) Take a vacation from doing dishes and give back to the environment when you are feeling better!

• If you live alone, ask someone to stay with you for as many  days as your surgeon suggests. Some surgeries will have you up and about the next day while others might take several weeks.  
• Keep pain medicine and a glass of water next to your bed before you go to sleep at night in case you need it  right away. 
• If you have children or pets, make sure the medication is safely stored.
• Get back to a routine as soon as you are able. Keeping your mind busy and focused on your job and/or life’s responsibilities will help keep your spirits up. We think that having too much free time to “think” can make it more difficult.

Radioactive Iodine Use Rising for Thyroid Cancer

        Use of radioactive iodine for thyroid cancer treatment after surgery increased significantly between 1990 and 2008, according to an analysis of more than 18,000 patients and 981 hospitals. Dr. Megan R. Haymart from the University of Michigan, Ann Arbor  discusses the results.

JAMA. 2011;306(7):721-728.

Radioactive Idoine 131: What is it and Why Should You Care?

Iodine-131 is a radioactive particle that is produced by the fission of uranium atoms within nuclear reactors. It can also be produced by plutonium and/or uranium in the detonation of nuclear weapons. Iodine-131 takes the solid form of a purplish-blackish crystal. It can undergo sublimation, which means it can go from a solid to a gas without first becoming a liquid. Iodine-131 dissolves in water.

Occurrence: 

• Iodine-131 can get into the environment through air or water.
• Being that Iodine-131 is created through fission, the substance matures within rods, but if the rods are not carefully monitored then pressure within the rod can increase, leading to corrosion and eventually leakage.
• Iodine-131 can get into water by a similar process; however it leaks into the liquid surrounding the cracked rod that is typically used to cool it. This liquid then circulates throughout the facility.
• While Iodine-131 has the tendency to attach to organic particles, such as soil, it can be spread fairly quickly through water.
• Iodine-131 can be ingested within water; since it dissolves in water it can easily move from the atmosphere to humans.
• Some doctors actually use small amounts of ingested Iodine-131 to detect thyroid problems.

Health Effects:

• Long term exposure to radioactive Idodine-131 can cause thyroid cancer.
• Low doses of Iodine-131 can also lower the activity of the thyroid gland by lowering the production of hormones.
• Doctors sometimes use small doses of Iodine-131 to treat an overactive thyroid, however the equilibrium must be perfect or the treatment will cause cancer in the area.
• If large quantities of Iodine-131 are released via some sort of nuclear accident, government agencies can use stable, non radioactive iodine to ensure that people do not absorb too much Iodine-131.

In The News:

Following the collapse of the Fukushima nuclear plant in Japan due to the earthquakes that took place in early March 2011, Iodine-131 has been a large concern of the world media.

• On March 23, 2011, the Los Angeles Times reported that tap water should not be consumed by infants in Japan due to the presence of Iodine-131 in the water.
• In March 2011, the Philadelphia Inquirer reported that officials had discovered Iodine-131 in rain water wells in Philadelphia, which were inspected to ensure that the collapse of the plant in Japan didn’t affect water in the U.S. However, the amount found was not lethal, and officials declared the water safe to drink.

Regulation:

The U.S. Environmental Protection Agency (EPA) has applied both water-based and airborne regulations to Iodine-131.

The regulations limit the amount of Iodine-131 that can legally be released by nuclear plants and various industrial facilities.

Water Treatment:

• EPA recommends that reverse osmosis be used to treat water containing Iodine-131.
• EPA also recommends the use of ion exchange to remove Iodine-131.

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Sources:

Forbes, Los Angeles Times, Philadelphia Inquirer, U.S. Environmental Protection Agency.

New radiation treatment practice recommendations for thyroid disease

New recommendations from the American Thyroid Association (ATA) on outpatient radioiodine (131I) treatment aim to minimize unintended radiation exposure and maximize the safety of patients, their families, and the public. The new ATA recommendations are presented in the April issue of Thyroid, a peer-reviewed journal published by Mary Ann Liebert, Inc

The ATA convened a task force to update radiation safety information related to outpatient 131I therapy to treat hyperthyroidism and thyroid cancer. The new ATA practice recommendations cover a broad range of topics including travel; safety precautions at home, work, and school; personal hygiene; and pregnancy and breastfeeding. 

These recommendations comply with the most up-to-date U.S. Nuclear Regulatory Commission (NRC) regulations, including a recent guidance statement that advises medical professionals administering 131I therapy to ask patients about their intended destination after the treatment and to discourage them from staying at hotels to limit public radiation exposure.

In a Commentary in the February issue of Thyroid, Richard T. Kloos, MD, Professor, The Ohio State University and Secretary/Chief Operating Officer of the ATA, states that the new ATA document "aims to provide simplified, consistent, and safe instructions for care providers and patients."

"The strength of these practice recommendations is that the task force included representatives across the range of disciplines that use radiation to treat thyroid patients. It is essential that our patients receive clear and consistent information from those ordering, administering, and monitoring these treatments," states Gregory A. Brent, MD, Professor of Medicine and Physiology, David Geffen School of Medicine at the University of California Los Angeles and President of the ATA.

More information: The ATA recommendations are available free online at  www.liebertpub.com/thy

Provided by Mary Ann Liebert, Inc

Iodine For Radiation: Who Needs It, And When

The extensive media coverage of the nuclear crisis in Japan, as well as the even more extensive reactions to it reverberating through cyberspace, suggest to me that there is fairly widespread confusion about both the risks of radiation, and the specific defense afforded by iodine supplementation. Drawing on general medical knowledge, rather than any dedicated expertise in radiation medicine, I write to clarify.

1) Thyroid hormones are manufactured by the thyroid gland using iodine. I believe it is commonly known that long-standing iodine deficiency leads to goiter, and hypothyroidism. In fact, goiter is still common in many parts of the developing world, and the World Health Organization supports an iodine distribution program to help combat that problem.

2) The thyroid gland can develop several kinds of cancer, and is more vulnerable to cancer to many other body sites because of its generally high rate of metabolic activity. Thyroid cells are especially vulnerable to the effects of radiation.

3) Nuclear fission reactions using uranium or plutonium release a variety of radioactive 'breakdown' products, and among these is radioiodine. There are several varieties of radioactive iodine, but I-131 tends to predominate.

4) The thyroid gland cannot distinguish between stable and radioactive iodine, so take up any available radioiodine just as assiduously as its stable counterpart. This is used under controlled medical conditions to treat disorders of the thyroid -- but under the uncontrolled conditions of a nuclear plant failure, I-131 exposure will potentially cause low-level radiation injury to thyroid cells -- enough to damage, but not kill them. Such injured cells are prone to develop cancers over time.

Iodine supplementation -- specifically the use of potassium iodide -- is potentially protective in two ways. First, if the the thyroid gland is saturated with stable iodine, it is less prone to take up any radioiodine because, in crude terms, there is no room at the inn.

Second, while iodine is essential for thyroid function and deficiency can cause hypothyroidism, high-dose iodine intake can actually cause hypothyroidism as well. This seemingly paradoxical response is called the Wolff-Chaikoff effect, and involves several mechanisms -- including suppression of the manufacture of thyroid hormones from the available iodine. It lasts only a short time, but for that time it will block the uptake of any more iodine into the gland.

I hasten to add that there is no reason for anyone in the U.S. to be taking iodine supplements to defend against radiation from the Japanese leak at this point; no meaningful risk currently exists here. And, there are two precautionary notes to sound. The first pertains to the 'well, it couldn't hurt' approach.

Actually, it could -- if iodine is supplemented after exposure to radioiodine, there is some possibility of it slowing thyroid function, and causing the radioactive iodine to remain in the gland longer. Second, iodine supplementation protects the thyroid gland only; it does not provide any kind of total body defense against the effects of radiation.

The iodine defense works against the threat of I-131, and the Japanese in the affected area should be using it. We in the U.S. should not. But we should understand it, so it's there for us if ever we need it. I certainly hope we don't.

SOURCE: The Huffington Post

About the Author: David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University’s Prevention Research Center at Griffin Hospital. He is a board certified specialist in both Internal Medicine and Preventive Medicine/Public Health; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; founder and president of the non-profit Turn the Tide Foundation. Learn More About Dr. Katz  http://www.davidkatzmd.com/  or visit

Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz

Radioactive Iodine Dosage for Thyroid Cancer Treatment

Radioactive iodine, I-131, can both cause and treat thyroid cancer. This and other isotopes were recognized as a cancer risk in the survivors of the nuclear bombs at Hiroshima and Nagasaki. Researchers found that higher doses can be used to destroy malignant thyroid tissue that may remain after surgical treatment. I-131 is produced in nuclear medicine reactors, and has a half-life of about 8 days. It decays into the inert gas xenon by emitting an electron and a gamma ray.

Radiation therapy for most cancers is done with an external beam. Thyroid cancer is exceptional because the tissue absorbs most of the iodine in the diet. Thus, radioactive iodine can deliver energy to the tumor cells very efficiently. The electrons are absorbed mostly by the tumor, while the gamma rays have a longer range.

A recent article reports that the optimum dose of radioiodine is a topic for discussion. There are two ways to calculate it: (1) bone marrow dose limited, or (2) lesion-based. Dosages from 1.1 to 21.4 GBq (gigabecquerels) have been reported. The Becquerel is a radioactive decay rate, equal to one disintegration per second.

Radioiodine therapy is simple and painless; the patient simply swallows the prepared dose. Most of it will be absorbed by thyroid tissue. The part that is not absorbed will be excreted in the urine over a period of about 2 days. Half of the absorbed dose will decay over the first 8 days. Over the next 8 days, half of the remaining amount will decay. This process continues until the last atom has decayed: the radioactive decay rate drops by half over each time span of the half-life (8 days for this isotope).

The patient will emit enough radiation to set off security detectors at airports and federal buildings for approximately months after treatment. Pregnancy is not recommended for at least six months to one year. Breast feeding is not allowed after radioiodine therapy. The patient should sleep alone and avoid prolonged contact with others for at least three or four days.

Clearly, there are risks to high doses of I-131. When you are radioactive enough to endanger others, you are subjecting your entire body to ionizing radiation. However, metastatic cancer is a serious risk as well. The authors of Reference 1 note there is evidence for both over-treatment and under-treatment, and more attention is needed to individualized therapy.

References:

1. Lassmann M et al, “Dosimetry and thyroid cancer: the individual dosage of radioiodine”,

Endocrine-Related Cancer 2010; 17:R161 – R172.

2. Radiation information from the Centers for Disease Control: http://www.bt.cdc.gov/radiation/pdf/measurement.pdf

3. More information online:  

http://www.radiologyinfo.org/en/info.cfm?pg=radioiodine

SOURCE:  Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Long Term Risks of I-131 RAI Treatment

In general, RAI (radioactive iodine) is a safe and effective treatment for the thyroid disorders mentioned in the prior blog posts. When RAI is used as treatment for hyperthyroidism, it is difficult to avoid development of hypothyroidism. Hypothyroidism is, therefore, watched for by your medical team and quickly treated with thyroid hormone pills.

Your doctor should discuss with you the risk of a small increase in the risk of developing thyroid cancers after RAI treatment for hyperthyroidism, although this has not been seen in all studies conducted, enough variables have been documented to warrant an informed discussion about the risk versus the individual benefits of RAI treatment for hyperthyroidism.

Although radiation kills cancer cells, it can also damage normal tissues and, over time, transform a small percentage of normal cells into cancer cells. This "second cancer" (if you are a thyroid cancer patient) develops in or near the previously treated radiation field, usually ten years or longer after initial radiation treatment has ended. The most common type of radiation induced cancer is sarcoma.

Importantly, then is that you must always remember that once you have been treated with RAI for any reason at all you need to have regular exams by your physician for the rest of your life. If you change doctors, see a dentist or have any emergency room treatment you must make sure you advise the treating provider that you have received RAI and when.

Doses of RAI used to treat thyroid cancers can cause permanent problems with the salivary glands leading to loss of taste and dry mouth. However, precaustions are taken to try to prevent these issues (i.e. using lemon drops or sour candy regularly for the first 14 days after RAI treatment). Temporary or permanent decreases in blood cell counts can also occur.

SPECIAL CONCERNS FOR WOMEN 

RAI, whether I-123 or I-131, should never be used in a patient who is pregnant or nursing. RAI given during pregnancy can damage the fetus (baby) thyroid gland. RAI given to a woman who is nursing can get into the breast milk and therefore expose the baby to radiation. Also, pregnancy should be put off a minimum of 6 months and preferably 12 months after RAI treatment since the ovaries are exposed to radiation during RAI treatment. Women who have not yet reached menopause are asked to fully discuss these precautions about the use of RAI with their doctors. There is no clear evidence that RAI leads to infertility.

SPECIAL CONCERNS FOR MEN

Men who receive RAI treatment for thyroid cancer may have decreased sperm counts and temporary infertility for periods of roughly 2 years. A doctor may discuss sperm banking with male patients who are expected to need several doses of RAI for thyroid cancer treatment.

GENERAL PRECAUTIONS FOR EVERYONE

Since I-131 RAI produces radiation, patients must do their best to avoid radiation exposure to others, particularly pregnant women and children under the age of 18, especially infants and small pets. Therefore, there are certain precautions that patients who have been treated with RAI are expected to follow after their treatment. These guidelines comply with the Nuclear Regulatory Commission and will be reviewed with patients by the medical institutions giving treatment on a case by case basis according to the dose used for individual patients.

Importantly, the amount of radiation exposure markedly decreases as the distance from patients increases. Patients who need to travel within six months from the time after receiving I-131 treatment and/or expect to visit federal government buildings are advised to carry a letter of explanation with them from their doctors. This is because radiation detection devices used at airports or in federal buildings may pick up even radiation levels considered safe and non-harmful to others.

I-131 Basics: Radioactive Iodine in the Treatment of Thyroid Cancer

As you probably already know, as a follower of my blog and facebook pages, my baby girl (22 years old, but forever my baby anyway) is a metastatic thyroid cancer patient. Most people simply assume that since thyroid cancer is generally referred to as a type of cancer with high cure rates and survival statistics, it is not a cancer we need to concern ourselves with much.

Well I hate to be the one to have to wake you up from the "fantasy" of a cancer many insensitive medical professionals and ill informed people call the "best cancer you can have".

~~Cancer~~ a devastating word to hear, and a phenomenally frightening diagnosis to deal with emotionally, physically and financially no matter the type, stage or age at onset.

In the case of thyroid cancer, the fastest increasing newly diagnosed cancer in America today, the many long term unknowns for the growing number of young survivors is not as reassuring as orignally thought of. A growing number of young people are developing persistent and/or recurrent cancer in the thyroid bed, many are developing metastatic disease like my daughter. Some may be genetically predisposed to the condition, many others will never know why they hit "the thyroid cancer lottery" at all. Yet another small percentage of survivors will develop another type of cancer somewhere down the line as result of the treatmetn they receive to treat the original thyroid cancer at an early age.

In this section/article I will share with you what nobody told me and you should know about I-131 RAI Treatment for thyroid disorders is the isotope used to destroy both normal and cancerous thyroid tissue.

1. NORMAL THYROID TISSUE:

Small doses of I-131 (5 t0 30 millicures, mCi) are given to destroy or "ablate" overactive thyroid tissue. This usually turns an overactive thyroid gland, with time, into and underactive thyroid gland. Doses of I-131 in the middle range (25 to 75 mCi) may be used to shrink large thyroid glands or goiters that are functioning normally but are causing breathing problems because their large size my compress the trachea (windpipe).

Patients must go directly home after I-131 RAI treatment, although they are asked to follow certain precautions. Temporary worsening of hyperthyroid symptons may occur within the first two weeks of I-131 treatment for hyperthyroidism, which can be easily treated with medicines called beta blockers. This medicine will be prescribed by your doctor. It is also common for patients to experience some temporary discomfort in the thyroid gland or lower neck area within 1 to 14 days after I-131 treatment for hyperthyroidism.

The discomfort may mimic the feeling of a sore throat. Aspirin, Ibuprofen (Advil) or Acetaminophen (Tylenol) may be used to treat discomfort. These side effects may last up to two weeks. The RAI treatment may take up to one to six months to have it's full effect. A small percentage of patients may require a second course of treatment.

2. THYROID CANCER TREATMENT:

Ablative doses of I-131 RAI (50 to 120 mCi) are usually given to destroy any remaining normal thyroid tissue that is commonly left following thyroidectomy. Because of the vital structures in the area of the thyroid gland, the surgeon may leave a small amount of thyroid tissue or gland behind, specially to preserve the tiny parathyroid glands that are embedded along the posterior (back side) of the thyroid gland. The remaining thyroid tissue will usually out-compete any thyroid cancer for the I-131 uptake ! Therefore, any residual thyroid tissue must be removed before persistent thyroid cancer or spread of thyroid cancer (metastatic disease) may be evaluated.

A post ablation thyroid scan is performed 10-14 days after thyroid ablation therapy which may show a large thyroid tumor, but mainly serves as a baseline study for future comparison. Larger doses of I-131 (80 to 200 mCi) are used to destroy residual thyroic cancer or any spread of the tumor to other sites or internal organs (metastatic disease). I-131 has been referred to as the "magic bullet" for treating most common types of thyroid cancer but as with any cancer early detection and early treatment are key in the race to cure theses types of cancers. In the case of my daughter Stevie JoEllie, but rarely in most cases, even higher doses of I-131 are given and most hospitals will generally keep you isolated in a special room anywhere from 24 hours to a few days to avoid exposing other people to radiation.

Please remember unless you receive unusually high doses of I-131 you will be allowed to return home the same day you receive your treatment, although precautions should be taken if you have small children or pets in your home, it is perfectly safe for most patients receiving small to medium I-131 doses to rest at home for a few days before returning to their regular activities. Keep in mind that since salivary glands weakly concentrate iodine, no matter what dose of I-131 you receive, there may be discomfort and swelling of the salivary glands. This can be prevented or greatly reduced by sucking on lemon drops or sour candies for up to 2 weeks after your I-131 treatment.

3. RADIATION EXPOSURE PRECAUTION INSTRUCTIONS AFTER I-131

This list outlines radiation exposure precautions to observe to minimize risks for your family, friends and co-workers after treatment. Please remember to consult your doctor and follow his instructions for YOU -- the precaution durations vary according to the dose of I-131 you receive.

ACTION DURATION

• Drink 12 -8oz glasses of fluids daily 2 to 7 days
• Do not prepare food for others 2 to 7 days
• Do not share utensils with others 2 to 7 days
• Flush toilet 2 to 3 times after each use 2 to 7 days
• Keep a distance of 6 feet from children 2 to 7 days
• Keep a distance of 6 feer from pets 2 to 7 days
• Sleep in a separate bed or room 2 to 11 days
• Avoid close physical contact such as hugs 2 to 11 days
• Avoid kissing and/or sexual activity 2 to 11 days
• Limit time in public places 2 to 7 days
• Delay return to work or school 2 to 7 days
• Do not travel by airplane of public transportation a minimum of 7 days but up to 14 days
• Do not travel on prolonged car rides or bus rides a minimum of 7 days but up to 14 days

FOR MORE INFORMATION TALK TO YOUR DOCTOR ABOUT HIS PERSONAL RECOMMENDATIONS FOR YOUR SPECIFIC CASE.

About the Author: Wilma Ariza is the founder of Stevie JoEllie's Cancer Care Fund a thyroid cancer awareness, access to care and free supportive services for thyroid cancer patients and survivors nonprofit 

Radioactive Iodine in the Diagnostic Process: Understanding I-123 Scans

When my then 21 year old diabetic daughter (pictured here) was formally diagnosed with thyroid cancer after a radical thyroidectomy on March 31, 2008 I had no idea what that would mean for her and her dreams as a young woman already dealing with a chronic health condition. She went into surgery to have thyroid nodules removed that had grown over the course of 4 years (after a number of inconclusive fine needle biospies) making it difficult for her to swallow and breathe.

The recovery room nurse whom I had met a year earlier and had come to know well when my daughter's father was diagnosed with stage IV esophageal cancer called me in to my daughter's bedside and explained that the surgeon performed a "more extensive surgery" than originally planned because "the thyroid was obviously malignant". Soon the surgeon came in and explained that waiting for the pathology report would be a formality for clinical confirmation but that the oncology department would have an endocrine oncology specialist consult the "case" during the course of my daughter's hospital stay.

I had never, before that moment, heard of 'thyroid cancer' in someone so young but we had "experienced" her fathers stage IV esophageal cancer treatment the year before and, in 2006, provided in-home hospice care for my father (her grandfather) diagnosed with terminal cancer after surviving leiomyosarcoma in 1998. Questions flooded my mind at the speed of lighting as I cried quietly while the doctors voice faded away and I could hear him no more; Would she have chemotherapy ? or radiation ? How about her voice ? Would she be able to talk ? Could she swallow again or would she need a feeding tube for survival like her father after receiving treatment for esophageal cancer. How about wound care ? How long would it take for her to heal as a diabetic ?

A ferocious maternal instinct kicked in almost instantly and I set out to learn as much as I could as fast as I could to take control of the situation and save my daughter from all the patient care and advocacy mistakes I made years earlier as my father's primary caregiver and healthcare proxy. Here I will share a summary review of what I learned about radioactive iodine uses for diagnostic testing of thyroid diseases (I-123) and the treatment of thyroid cancer (I-131).

Let's begin with I-123 in the diagnostic process also known as thyroid scan or radioactive iodine uptake test (RAIU)

1. THE THYROID GLAND & IODINE:  

Iodine is essential for proper function of the thyroid gland, which uses it to make the thyroid hormones our body relies on for proper metabolic function and other systematic biological functions such as heart rate, body temperature, calcium absorption, the reproductive system and more. The thyroid is equipped with an active system or "pump" for moving iodine into it's cells. Thyroid cancer cells usually take up iodine also, "although they do not this as well as normal thyroid cells".The ability of thyroid cells to take up iodine has been used by medical professionals to treat various thyroid diseases for decades.

2. WHAT IS RADIOACTIVE IODINE (RAI)? 

A radioactive isotope is a substance that gives off radiation. Iodine can be made into two radioactive isotopes for medical uses: I-123 and I-131. These isotopes can be given by mouth to patients with suspected thyroid conditions. RAI is then concentrated inside the thyroid cells exactly like iodine and can be used to diagnose or treat thyroid problems. The radiation that RAI gives off can either be harmless to the thyroid cells (I-123) or the radiation my destroy the thyroid cells (I-131). RAI that is not concentrated in the thyroid gland is eliminated from the body through sweat and urine. RAI is safe to use in individuals who have had an allergic reaction to seafood or X-Ray contrast agents, since the allergic reaction is to the compound continaing iodine, not the iodine itself.

3. RAI FOR THYROID IMAGING: 

I-123 is the isotope used to take the pictures of the thyroid gland during a Thyroid Scan. A very small "tracer" dose of I-123 is given to the patient, who then returns 3-8 hours later so "pictures" of the thyroid gland can be taken using a "camera" that picks up the radiation emitted by the RAI. The "camera" is part of a machine that looks similar to an X-Ray or CAT Scan machine. In addition to getting the scan or picture, the amount of radiation being given off can also be counted to determine how "active" the thyroid gland is also know as a Radioactive Iodine Uptake (RAIU). Since the radiation emitted by I-123 is harmless, no special precautions are necessary after a thyroid scan or RAIU. The total radiation iodine dose that you receive during a thyroid scan is less than you would get if you had a routine chest x-ray. There are usually no side effects to I-123.

FOR MORE INFORMATION TALK WITH YOUR DOCTOR


About The Author: Wilma Ariza is the Founder of Stevie JoEllie's Cancer Care Fund a thyroid cancer awareness, access to care and free supportive services for thyroid cancer patients and survivors nonprofit.