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.
Low-iodine diet
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.
The Benefits Of Radioactive Iodine Ablation For Patients With Intermediate
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Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Writing original draft
Affiliation Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
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Roles Formal analysis, Methodology, Project administration, Supervision, Validation, Visualization, Writing review & editing
Affiliation Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
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Roles Formal analysis, Methodology, Supervision, Validation, Visualization, Writing review & editing
Affiliation Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
Papillary Thyroid Cancer Surgery In Sites Other Than The Neck
Papillary thyroid cancer surgery is uncommonly proposed as a treatment approach when disease has spread to distant sites. Although surgery is not commonly proposed for distant spread of papillary thyroid cancer, consideration for surgery for distant disease is based upon the expert thyroid cancer team evaluation and considers the following issues:
- Where is the papillary thyroid cancer distant disease located?
- What are the risks and benefits of surgery?
- Are there other sites of distant spread?
- What papillary thyroid cancer treatments have already been used?
- What were the outcomes of other treatments for the papillary thyroid cancer?
- How fast is the papillary thyroid cancer growing?
- What are the patient’s treatment desires?
- What are the other treatment options?
- What is the papillary thyroid cancer pathologic type (what do the cells look like under the microscope?
- What are the papillary thyroid cancer genetic mutations?
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Extended Or Complicated Thyroidectomy
Papillary thyroid cancer may sometimes be more aggressive than ultrasound or CT imaging suggested prior to undergoing surgery. In these cases, an expert surgeon that recognizes those “more aggressive” intraoperative findings such as growth or extension of the cancer outside of the thyroid gland or invasion of the cancer into adjacent structures such as the nerve to the voice box , breathing tube , voice box, or esophagus must adapt the surgery to adequately address the complete removal of the cancer. Unfortunately, occasional thyroid surgeons are commonly unprepared to perform the appropriate surgery and a subsequent surgery for persistent disease will be required.
The Importance Of Clinical Trials
Clinical trials are the standard by which we measure the worth of new treatments and the quality of life of patients as they receive those treatments. For this reason, doctors and researchers urge people with cancer to take part in clinical trials.
Your doctor can guide you in making a decision about whether a clinical trial is right for you. Here are a few things that you should know:
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Often, people who take part in clinical trials gain access to and benefit from new valuable treatments.
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Before you participate in a clinical trial, you will be fully informed as to the risks and benefits of the trial, including any possible side effects.
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Most clinical trials are designed to test a new treatment against a standard treatment to find out whether the new treatment has any added benefit
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You can stop taking part in a clinical trial at any time for any reason.
All cancer treatments can cause side effects. Its important that you report any side effects that you experience to your health care team so they can help you manage them. Report them right awaydont wait for your next appointment. Doing so will improve your quality of life and allow you to stick with your treatment plan. Its important to remember that not all people experience all side effects, and people may experience side effects not listed here.
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Thyroid Hormone Suppressive Therapy For Papillary Thyroid Cancer
Thyroid hormone is a necessary hormone for life. The thyroid gland normally produces thyroid hormone to adequate levels. The amount of thyroid hormone produced by the body is strictly controlled by a portion of the brain called the pituitary gland. When the body has too little thyroid hormone, the pituitary gland senses the low levels and produces TSH . When thyroid hormone levels are elevated , the pituitary does the opposite and lowers its production of TSH. This is called an endocrine feedback loop.
Most papillary thyroid cancer cells and all normal thyroid cells have a site on the surface of the cell that can stimulate their growth. This site is called a “receptor” and when stimulated by TSH in normal thyroid cells, it causes increased production of thyroid hormone. In papillary thyroid cancer cells, this same TSH receptor can stimulate the growth of these cancer cells. Obviously, it is an undesirable concept to have TSH stimulate papillary thyroid cancer cells to grow. Therefore, the goal in the papillary thyroid cancer patient is to keep TSH levels low. So how is this done?
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
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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.
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 bodys 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 glands cells.
Doctors also use radioactive iodine I-131 to treat thyroid cancer.
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Papillary Thyroid Cancer Surgery For Spread Of Cancer To Lymph Nodes Along The Side Of The Neck
- Just the presence of enlarged lymph nodes does not mean papillary thyroid cancer has spread and does not require additional surgery
- A procedure called an anterolateral neck dissection , in untreated patients, should only be performed in instances where an ultrasound with fine needle aspiration has confirmed papillary thyroid cancer spread to lymph nodes in the side of the neck
- The papillary thyroid cancer anterolateral neck dissection is not the same neck dissection as for other cancers that occur in the neck. Papillary thyroid cancer spreads to particular areas of the neck called levels. Removing just some of the lymph nodes has been called “cherry picking” and is the wrong surgery! A papillary thyroid expert surgeon trained and experienced to perform modified neck dissections specifically for thyroid cancer is needed to prevent recurrent or persistent disease.
- The anterolateral neck dissection, in skilled hands, spares all critical nerves, muscles, and blood vessels which are not directly involved with cancer . It ads approximately 40 minutes of surgery to remove the lymph nodes and fatty tissue.
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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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.
Preparing For Radioactive Iodine Treatment For Thyroid Cancer
Radioactive iodine treatment is a type of internal radiotherapy. It uses a radioactive form of iodine called iodine 131 . It is a useful treatment in thyroid cancer because the thyroid gland absorbs and stores most of the iodine in your body. The thyroid gland gets iodine from certain foods and uses this to make essential thyroid hormones.
Radioactive iodine is a targeted treatment. The radioactive iodine circulates throughout your body in your bloodstream. But it is mainly taken up by thyroid cells, having little effect on other cells. Thyroid cancer cells in your body pick up the iodine. The radiation in the iodine then kills the cancer cells.
It is only suitable for some types of thyroid cancer. It is a treatment for:
- follicular thyroid cancer
- papillary thyroid cancer
It can treat the cancer even if it has spread. But even if you have one of these types of thyroid cancer, this treatment may not be necessary or suitable for you. Not all of the cancer cells take up the iodine so you may have a test dose to see if they do.
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Papillary Thyroid Cancer Surgery For Central Compartment Lymph Nodes And Swallowing Tube
The removal of the lymph nodes of the central neck can be performed initially when the thyroid gland is removed in the treatment of papillary thyroid cancer or following the initial surgery in the less common circumstances when papillary thyroid cancer recurs or persists. The central compartment lymph node surgery spares all critical structures including the nerves to the voice box and all parathyroid glands not directly involved by cancer. Central compartment dissection extends from the carotid arteries on both sides of the neck, below to the blood vessels of the upper chest, and above to where the blood vessel of the upper portion of the thyroid gland begins off of the carotid artery .
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 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
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Radioactive Iodine Treatment Of Papillary Thyroid Carcinoma In Japan
Takahiro Okamoto1, Yoko Omi1, Yusaku Yoshida1, Kiyomi Horiuchi1, Koichiro Abe2
1Department of Breast and Endocrine Surgery, Tokyo Womens Medical University, Shinjuku-ku, Tokyo 2Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo , Japan
Contributions: Conception and design: All authors Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Keywords: Radioactive iodine outpatient-based ablation papillary thyroid carcinoma risk classification clinical practice guidelines
Submitted Mar 21, 2020. Accepted for publication May 17, 2020.
doi: 10.21037/gs-20-378
Dynamic Evaluations And Decisions
The definitions of RAI ablative or adjuvant therapy are apparent. However, clinical judgments may change according to the findings of imaging studies and serum Tg levels . When a patient is found to have residual accumulations outside the thyroid beds on the whole-body scan following RAI administration and the lesions are confirmed by other imaging modalities, the individual must have treatments with either RAI 3,700 MBq or salvage surgery. In contrast, if the scan shows I-131 accumulation in the thyroid bed alone, then a decision will be made based on a follow-up diagnostic scan and serum Tg level at 612 months. A patient has no residual disease when the DxWBS shows no accumulation of RAI and stimulated Tg level < 2 ng/mL. In patients with uncertain responses defined by either a positive DxWBS scan at the thyroid bed or stimulated Tg level 2 ng/mL, a second administration of RAI 1,110 MBq needs to be considered.
Figure 9
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