Monday, March 20, 2023

I 131 For Thyroid Cancer Treatment

Can I Have Visitors

I-131 Therapy for Thyroid Cancer

You may have visitors from the day after you receive your treatment, provided the visitors are over 18 years of age and not pregnant . Visitors must:

  • Stay at least 2 metres from you (we ask that they sit on chairs near the door and you sit on the armchair near the window.
  • Wear gloves and overshoes , removing and disposing of these when they leave.
  • Not eat and drink whilst in the room.
  • Stay for a maximum of 1 hour each day.

Your visitors may bring items in for you such as books, newspapers and food but they must not take anything out of the room.

How Rai Therapy Works

Your thyroid gland takes up most of the iodine in your body. By making the iodine radioactive , it becomes toxic to cells that collect iodine from your body, in turn killing these cells. This treatment can be used:

  • To destroy any thyroid tissue that was not removed during surgery.
  • To treat some thyroid cancers that have spread to lymph nodes and other parts of the body.

Differentiated Thyroid Carcinoma Derived From Ectopic Tissue

Sublingual area is the most common place for ectopic thyroid development. Insufficient T4 production in ectopic tissue may cause TSH elevation and thus hyperplasia by stimulation. Long-term and intense TSH stimulation is blamed for carcinoma development in these cases. Thyroglossal canal originated papillary carcinoma may have an invasive character in 10% of the cases . In 3% of the cases, ectopic thyroid tissue is found in ovarian teratoma . Low-grade malignant tumor may arise from struma ovarii , and some may metastasize . Although management approaches are still uncertain, treatment of cancer of an aberrant thyroid tissue is the excision of the tumor followed by radioiodine therapy.

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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 .

How Does Radioactive Iodine Treat Thyroid Cancer

sodium iodide capsule radioactive iodine 131

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.

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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

How Long Does The Radioiodine Stay In Your Body

Radioiodine stays in your body for only a short time. Most of the radioiodine that does not go to thyroid tissue will be eliminated from your body during the first few days after treatment. Radioiodine leaves your body primarily through your urine, but very small amounts can be found in your saliva, sweat and bowel movements.

Ask your doctor for more information. You also may get more information from the Society of Nuclear Medicine and Molecular Imaging at www.snmmi.org.

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How Do I Prepare For The Treatment

You may need to stop taking certain drugs for several days or weeks before your appointment or have some injections in preparation for the treatment. Your appointment letter will give further details of what is required.

You will need to follow a low iodine diet and avoid medications containing iodine for 2 weeks prior to the therapy.

See the separate leaflet Thyroid Tests and Treatments: The Recommended Low Iodine Diet for advice.

On the day of the treatment, you will need to fast from early in the morning. You may drink as usual. Your appointment letter will give more details.

There is some information which we need in advance. This is so we can plan your treatment. Please call the Nuclear Medicine Department before your appointment if any of the following applies to you:

  • You have any problems with controlling your bladder, for example, if you wear pads or have a catheter.
  • You are unable to look after yourself in a single hospital room for up to 5 days without assistance from anyone else.
  • You have had any X-ray procedures involving the use of contrast in the 8 weeks prior to your appointment date.
  • You look after young children. .
  • Your home is not connected to the mains drainage / sewer system .
  • You do not have a washing machine at home to wash your clothes following the treatment. Contaminated clothing cannot be washed at a public launderette.
  • You live in a residential care home or nursing home.
  • For female patients:
  • If there is any chance that you might be pregnant.
  • How Thyroid Cancer Is Treated

    Does I-131 Treatment of Thyroid Disease Cause Cancer? with Dr. Kim

    In many cases, a team of doctors works together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For thyroid cancer, this team may include a surgeon, medical oncologist, radiation oncologist, radiologist, nuclear medicine physician, and endocrinologist. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, speech therapists, and others.

    Thyroid cancer is commonly treated by one or a combination of treatments. The common types of treatments used for thyroid cancer are listed below, followed by an outline of common cancer treatments given by stage of disease .

    Treatment options and recommendations depend on several factors, including the type and stage of thyroid cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Talk with your health care team about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called shared decision-making. Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for thyroid cancer because there are different treatment options.

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    Can There Be Any Complications Or Risks

    Radioiodine is a very safe treatment but like everything in life, there may be a small degree of risk. Your doctor will only prescribe this treatment if the benefits to you outweigh any potential risks.

    Side effects with I-131 are uncommon. Some patients have reported that their mouth, throat or neck has become slightly swollen or sore. Please let the nursing staff know if you experience any side effects as they can provide advice and may give you some medication to ease any discomfort.

    Sometimes people find that their sense of taste is slightly altered but this usually improves several days or weeks after your treatment. Citrus fruit sweets, which encourage the production of saliva, can often help but these should only be used 24 hours after you have taken your I-131 capsule.

    Whilst there is no evidence of people being harmed from the radiation associated with this treatment, some people believe there is no such thing as a safe dose of radiation, no matter how small. Therefore, we use the minimum amount of radiation needed to treat you. However, the radiation could be harmful to an unborn baby so the treatment must not be given to patients who are pregnant. Radio iodine can also pass into breast milk therefore the treatment is unsuitable for patients who are breastfeeding.

    After you have had the therapy, we advise women to avoid conception for six months and men to avoid fathering children for four months.

    What precautions do I need to follow after the treatment?

    Other Things You Should Know During The First Week After Treatment:

    Small amounts of radiation from your body may trigger radiation monitors at airports, border crossings, government buildings, hospitals, and waste disposal sites for up to 3 months after treatment. Ask your doctor for advice if you will be in these areas. Your doctor can provide you with a letter describing your medical treatment if you cannot avoid these areas.

    Discarded items that are heavily stained with urine, saliva, nasal secretions, sweat or blood may trigger alarms at waste disposal sites. Ask your doctor for advice on how to safely dispose of these items.

    This information may be used to meet the requirements of the U.S. Nuclear Regulatory Commission for giving written instructions to patients following treatment with radioiodine.More specific instructions may be required in certain circumstances.

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    Treatment Options: Role Of Radioiodine

    Front-line therapy of differentiated thyroid cancer is surgery. Because multifocality and multicentricity is frequent, total or near-total thyroidectomy is the treatment of choice. Samaan et al. have reported that recurrence rates were lower and survival rates were higher in total thyroidectomized patients . Following total thyroidectomy, I-131 is given for ablation of residual thyroid tissue and treatment of metastatic disease. To achieve a successful ablation and treatment, I-131 should be taken up by residual thyroid and metastatic tumors. The function of cancerous follicular cells is poorer than normal follicular cells. While normal thyroid tissue concentrates 0.51.0% of the administered I-131 dose, cancerous cells concentrate 0.010.02%.

    Papillary cancer , follicular cancer, less than 10% of Hurthle cell variant papillary cancer, and mixed variant medullary cancer show I-131 uptake . Ablation is defined as the radioiodine therapy given for destruction of functional residual thyroid tissue in or out of the thyroid bed. Therapy is the term used for sterilization of residual functional tumoral cells. As the volume of residual thyroid decreases, success of ablation increases. If residual thyroid tissue weighed < 2 grams , ablation efficiency was reported as 94%, while this rate may fall as low as 64% in larger residues .

    When To Have Rai Treatment

    Therapy with Radioiodine in Adults and Children with Differentiated ...

    RAI is generally not given until some weeks after surgery, once any swelling has gone down. This is because swelling can affect the blood flow and stop the RAI circulating well.

    It is not safe to have RAI treatment if you are pregnant or breastfeeding, so treatment may be delayed. RAI may be given up to six months after surgery. Ask your doctor for more information.

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    Breastfeeding And Radioactive Iodine Therapy

    Radioactive iodine can collect in breast tissue with milk in it. To prevent having radioactive iodine collect in your breast after your treatment, youll need to stop breastfeeding or pumping breast milk at least 6 to 12 weeks before your treatment.

    You wont be able to continue breastfeeding after your treatment because your breast milk can expose your baby to radiation. If you have any questions about breastfeeding and your treatment, talk with your doctor or call the Department of Medical Physics at .

    The Radioactive Iodine Efficiency For The Treatment Of Well

    Modallal Mohammad1*, Muntaser S. Ahmad1, Mudalal M2, Bakry A1 and Arzeqat T1
    1 Department Of Medical Imaging, Faculty Of Allied Medical Health, Palestine Ahliya University, Jabal Daher, PO.Box 1041 Bethlehem, Palestine
    2 Department Of Oral And Maxillofacial Surgery And Periodontology, Faculty Of Dentistry, The Arab American University, Jenin, 240, Palestine
    *Corresponding Author:

    Tel:Received DateAccepted DateDOI:

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    Remission And The Chance Of Recurrence

    A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

    A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

    If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .

    If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options.

    Often the treatment plan will include the treatments described above, such as surgery, radioactive iodine therapy, targeted therapy, external-beam radiation therapy, hormone therapy, and chemotherapy. However, they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent thyroid cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

    Risks And Side Effects

    Radioactive Iodine Therapy | Thyroid Cancer Update

    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:

    • Neck tenderness and swelling

    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.

    Last Revised: March 14, 2019

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    What Is Low Risk Differentiated Thyroid Cancer

    The main point in the argument of whether to treat or not patients with low risk lies in the definition of low risk itself. At present, different guidelines have established several definitions.4, 12, 13, 14, 15

    First of all, there is no agreement as to what risk should be evaluated – the risk of death related to DTC or the risk of recurrence. Different guidelines include different parameters to construct the classification, but most take into account tumoral size, the relation with the

    General Principle Behind Ablative Therapy And Treatment Of Metastases Using 131i

    Although most thyroid carcinomas can be removed surgically, this involves extensive, methodic, and painstaking surgical procedures to preserve the recurrent laryngeal nerve and the parathyroid glands, which may be embedded in the thyroid gland. The consequence of an aggressive surgical approach produces significant morbidity, sometimes permanent hypoparathyroidism or recurrent laryngeal nerve paralysis. For this reason, a near-total thyroidectomy is the current standard of care. Any residual thyroid tissue may very well be normal tissue without any evidence of malignancy. To localize the possible presence of regional or distant functioning thyroid metastases by radioiodine, however, it is almost always necessary to render any remaining thyroid tissue nonfunctional. The postsurgical residual functioning thyroid tissue can be ablated using 131I. The first report of radioiodine therapy for metastatic thyroid carcinoma was in 1945 . The efficacy of radioiodine therapy is directly related to tumor uptake and retention. Effective tumor uptake is achieved if there is a concentration of 0.5% of the dose per gram of tumor tissue with an effective half-life of at least 4 d. The radiation absorbed dose delivered to thyroid tissue is related to the activity administered and the fraction of the dose that is taken up by the thyroid tissue. In the above-mentioned situation, administration of 5.55 GBq 131I would deliver a tumor dose of approximately 25,000 rad .

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