Preparation For Rai Administration
Recommendation 5: Recombinant human TSH during l-T4 treatment should be the preferred method of preparation for RAI administration.
Remnant ablation has historically been performed after prolonged l-T4 withdrawal to increase endogenous thyroid-stimulating hormone to levels sufficient to induce robust RAI uptake in thyroid cells. However, this induces hypothyroidism with a major decrease in quality of life, which may last for up to 23 months. Empirically, it is estimated that a TSH > 30 mU/L is a good cut-off , but no comparative study has ever validated this assumption and more recent results seem to contradict this assumption . For thyroid hormone withdrawal, two possible approaches are used: switch from l-T4 to triiodothyronine for 23 weeks and then stop l-T3 for 2 weeks, or stop L-T4 for 34 weeks without switching to l-T3. Either method will significantly decrease quality of life. Alternatively, induction of a less prominent hypothyroidism has also been proposed .
Rai Frequently Asked Questions
- Can I isolate myself in a hotel room? No, this is not recommended as there is potential that the housekeeping staff will come in contact with the RAI you discharge from your body. This may include pregnant women.
- How do I protect my children? If you have young children, it is best that they stay with a relative for the first few days, or that you stay in hospital isolation. Other alternatives are: a basement apartment, a cottage, or friends empty house/rooms.
- What after-effects can I expect? Most people have few after-effects or they are very temporary. Almost all patients treated with RAI have an altered sense of taste for the first few days or weeks . Infrequently, the effect lasts longer.
- In some cases, patients experience RAI damage to their salivary glands and/or tear ducts . For most people, the effects are temporary. Those who have lasting effects may experience mild pain in their cheeks, mouth dryness and/or blocked tear ducts. Some may require treatment from specialists in corresponding fields of medicine.
- Occasionally, months later, patients feel some after-effects of RAI as soreness or swelling in glands . This usually lasts less than two weeks.
Who Is Part Of A Thyroid Cancer Treatment Team
I think of thyroid cancer treatment really as a team approach because no single area of medicine is entirely responsible for the patient’s care, Dr. Hancock said. Everybody has a different role.
That treatment team can include:
- An endocrinologist, who helps with diagnosis and follow-up testing and care
- An ear, nose and throat surgeon, or a general surgeon trained in endocrine surgery
- A nuclear medicine specialist if radioactive iodine is needed
- A radiation oncologist if external radiation is needed
- An oncologist, if traditional chemotherapy is needed
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Enhancing Healthcare Team Outcomes
The appropriate treatment for DTC is surgery followed with or without radioactive iodine. The necessity and the amount of radioactive iodine to be administered are determined on an individual basis as per the risk category of the patient and institutional protocol. Assessing the patient risk, the need for radioiodine therapy, determining the dose, administering the dose, maintaining radiation safety protocol, and making sure the patient is compliant with the protocol requires an interprofessional team approach including primary care clinician, endocrinologist, pathologist, Nuclear Medicine physician, radiopharmacy staff, nurses, technologists, and radiation safety officer.
An evidence-based integrated management approach brings superior results. The interprofessional team should educate the patient about the risks and benefits of RAI treatment. The patient should be informed of the importance of following a low iodine diet before therapy.
There should be efficient provider-patient communication, and giving proper radiation safety instructions to the patient is essential. Small children or pregnant partners should not accompany the patient while arriving for treatment. Female patients of reproductive age should have a negative serum pregnancy test to proceed with RAI treatment. The patient should be made aware of the possible short and long-term side effects of RAI treatment.
How Is Radioactive Iodine For Thyroid Cancer Administered
Depending on the facility, an endocrinologist, nuclear medicine physician or radiation oncologist can administer the oral treatment. Most people will have one or two doses of RAI after thyroid cancer surgery.
RAI treatment is a three-day, outpatient process for most people.
Day 1 includes blood tests and a thyrotropin alfa shot. Thyrotropin alfa helps any leftover thyroid tissue absorb the RAI.
On Day 2, you will get a second dose of thyrotropin alfa and a small dose of RAI. Then, you will have a full body scan so your doctor can see how your body will absorb the iodine.
On Day 3, you will receive the full dose of RAI, followed by a full body scan several days later.
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Radioactive Iodine For Thyroid Cancer
Radioactive iodine can help reduce the risk of thyroid cancer from coming back after surgery, and treat thyroid cancer that has spread
By Dr. Susana-Vargas-Pinto, Endocrine Surgery, Nuvance Health
Yes, you will be radioactive after you ingest radioactive iodine to treat thyroid cancer. While thats the most common question patients ask, here are answers to other questions about this treatment for thyroid cancer.
Thyroid cancer happens when cells grow out of control in the small, butterfly-shaped gland in the lower front of your neck.
Most people will only need surgery to treat early-stage thyroid cancer that has not spread. An endocrine surgeon or head and neck surgeonwho specializes in thyroid surgery treats thyroid cancer. The type of thyroid surgeryyou need depends on the kind of cancer you have.
Your care team may recommend radioactive iodine , also called I-131, after a thyroidectomy to lower the risk of the cancer coming back. They may also recommend RAI to treat thyroid cancer that has spread.
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:
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How Can You Prepare For Radiative Iodine Treatment
Your care team will help prepare you for RAI treatment. At Nuvance Health, the team includes registered dietitians who are certified oncology nutritionists. You will need to follow a low-iodine diet for about a week before your treatment.
You may need to avoid foods high in iodine, such as iodized salt, some breads, cereals and grains, fish including shellfish, beef, poultry and dairy products.
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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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.
Preparation Of A Follicular Thyroid Cancer Patient For Radioactive Iodine Treatment
Follicular 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, follicular 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 follicular thyroid cancer patient.
- Dry mouth and or eyes
- Narrowing of the drainage duct of the eye’s 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
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When To Have Rai Treatment
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.
What To Expect During Treatment
RAI is usually given in pill form. A liquid form is also available if you have trouble swallowing pills. Once you take the pill will you not be able to eat or drink for a few hours, so your body can take in the iodine. Then you will be asked to drink lots of fluids to get rid of the excess RAI and you can eat like normal.
This treatment will make you radioactive and you may need to stay in the hospital for a few days after treatment. You may have imaging tests done to see where the iodine has been absorbed in your body.
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Radioactive Iodine Treatment For Papillary Thyroid Cancer
The mechanism of how RAI Treatment works to treat thyroid cancer was not discovered until years following its use to treat papillary thyroid cancers. We now know today that papillary thyroid cancers can possess a type of key hole on the surface of their cell called a symporter that allows iodine to be taken into the cell. Under normal circumstances, iodine is taken up by normal thyroid cells in the process of producing the bodys thyroid hormone. Although papillary thyroid cancer rarely produces thyroid hormone itself, it frequently maintains this iodine symporter and ability to take up iodine. In the treatment of papillary thyroid cancer, this can be taken advantage of by having the patient swallow an iodine pill that has been radioactively charged.
The papillary thyroid cancer patient swallows a radioactive iodine form of iodine called iodine 131 in a liquid or pill form. The RAI is absorbed through digestion and circulated throughout the body in bloodstream. Papillary thyroid cancer cells can pick up the radioactive iodine wherever they are located in the body. Once taken into the papillary thyroid cancer cells, the radioactive iodine delivers a local radiation treatment in the area where the iodine is concentrated.
After Radioactive Iodine Therapy
The therapy makes you radioactive for a few days. There is a chance that the hospital staff and your relatives and friends might be exposed to the radiation. No visitors are allowed for the first 24 hours. After that they are only allowed in your room for a short time each day, one at a time and they must stay at a distance from you. Lead screens may be placed on either side of your bed or in the doorway to block any radiation. Children under 14 and pregnant women will not be allowed to visit you for up to 5 days.
It is best to drink lots of fluids as this will get rid of the radioactivity quicker. The medical physicist will measure your radiation levels every day to make sure they have dropped to a safe level. Usually after 3 days you will be allowed home. Usually a whole body scan is done before you go home or the following week.
Feeling isolated: You might feel lonely, afraid and even depressed having to stay in isolation. Tell your nurses how youre feeling. Usually there is a telephone in the room or you can use a mobile phone to talk to your family and friends.
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Treatment For Thyroid Cancer
Radioactive iodine therapy, often referred to as RAI, is used following surgery for certain types of thyroid cancer specifically, follicular and papillary and may also be useful for some differentiated types.
Read about other in our Patients’ Guide to Thyroid Cancer.
A thyroidectomy is a type of thyroid surgery used to remove the thyroid when cancer is present. However, some thyroid cells may remain after the procedure To prevent thyroid cancer recurrence, RAI is done to kill any remaining, possibly cancerous, thyroid cells.
Should thyroid cancer spread to other parts of the body, radioactive iodine is often recommended to distroy those cells, as well.
What Are The Special Concerns For Women
RAI, whether I-123 or I-131, should never be used in a patient who is pregnant or nursing. This protects the baby who would otherwise receive radioactive milk and the mothers breasts which concentrate RAI. Breastfeeding must be stopped at least 6 weeks before administration of I-131 treatment and should not be restarted after administration of RAI, but can be safely done after future pregnancies. Also, pregnancy should be put off until at least 6 12 months after I-131 RAI treatment since the ovaries are exposed to radiation after the treatment and to ensure that thyroid hormone levels are normal and stable prior to pregnancy. There is no clear evidence that RAI leads to infertility.
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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.
Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance
Noone A, et al. SEER cancer statistics review, 19752015. Bethesda, MD: National Cancer Institute 2018.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 26:1133.
Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metabol. 2006 91:28929.
Chung J-K. Sodium iodide symporter: its role in nuclear medicine. J Nucl Med. 2002 43:1188200.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline . Eur J Cancer. 2009 45:22847.
Sherman S. Cytotoxic chemotherapy for differentiated thyroid carcinoma. Clin Oncol. 2010 22:4648.
Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, et al. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 372:62130.
National Comprehensive Cancer Network. Thyroid Carcinoma . July 26, 2019] Available from: .
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Rai Treatment For Different Types Of Thyroid Cancer
To be effective, your thyroid cancer must be the type that absorbs radioactive iodine.
Studies show that RAI therapy increases how long some people with the following types of thyroid cancer live:
- follicular thyroid cancer
- papillary thyroid cancer that has spread
RAI therapy sometimes helps control the disease in people with differentiated thyroidcancer that that appears likely to spread or has already spread.
What Is Radioiodine Therapy And How Is It Used
Radioactive Iodine I-131 therapy is a nuclear medicine treatment. Doctors use it to treat an overactive thyroid, a condition called hyperthyroidism. Hyperthyroidism can be caused by Graves’ disease, in which the entire thyroid gland is overactive, or by nodules within the gland which are locally overactive in producing too much thyroid hormone.
Nuclear medicine uses small amounts of radioactive material called radiotracers. Doctors use nuclear medicine to diagnose, evaluate, and treat various diseases. These include cancer, heart disease, gastrointestinal, endocrine, or neurological disorders, and other conditions. Nuclear medicine exams pinpoint molecular activity. This gives them the potential to find disease in its earliest stages. They can also show whether you are responding to treatment.
The thyroid is a gland in the neck that produces two hormones. These hormones regulate all aspects of the body’s metabolism, the chemical process of converting food into energy. When a thyroid gland is overactive, it produces too much of these hormones, accelerating the metabolism.
Radioactive iodine , an isotope of iodine that emits radiation, is used for medical purposes. When a small dose of I-131 is swallowed, it is absorbed into the bloodstream in the gastrointestinal tract. It is concentrated from the blood by the thyroid gland, where it begins destroying the gland’s cells.
Doctors also use radioactive iodine I-131 to treat thyroid cancer.
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