Radioactive Iodine Therapy: Indications
RAI therapy has been approved for therapeutic use on both benign and malignant thyroid conditions. For instance, it is indicated for the management of overactive thyroid tissue and some types of thyroid cancer. Also, this therapy can be used to decrease the size of glands that are not hyperfunctioning but are causing signs or symptoms due to their size. Concrete indications for RAI therapy are:1
- Graves disease
Toxic nodular goiter
The goal of treatment in multinodular goiter and toxic adenoma is the rapid and long-lasting resolution of hyperthyroidism. Along with surgery, RAI therapy is one of the definitive treatments for this condition. It can decrease the size of the nodules, thereby reducing the signs and symptoms of hyperthyroidism.2 A single dose has been shown to reduce goiter size by up to 40% and it usually succeeds in 85-100% of patients with toxic nodular goiter.2
In these conditions, possible indications for RAI therapy include advanced age, small goiter size, significant coexistent diseases, and prior surgery or scarring of the anterior neck.3
Large doses of RAI may also be useful to treat certain types of thyroid cancer. It is usually helpful for patients with papillary and follicular carcinomas. However, it is of no use in cases of medullary thyroid carcinoma and anaplastic carcinoma because these tumors dont take up radioactive iodine.4
Non-Toxic Multinodular Goiter
What To Expect During Radiation Therapy
Doctors may use intensity modulated radiation therapy, in which radiation beams are broken into many small, computer-controlled doses of different strengths. These minibeams come from different directions and are tailored to the size, shape, and location of the tumor.
The radiation beams may be aimed at the area where the thyroid gland was removed or at cancerous lymph nodes in people who cannot undergo surgery. Treatment is delivered in small dosesor fractionsonce a day, five days a week, for six or seven weeks.
Radiation therapy may cause side effects such as fatigue and dry mouth. Your doctor may prescribe medication and refer you to NYU Langones integrative health services for help in minimizing side effects.
Thyroid Medicine After Radioactive Iodine Treatment
You may have stopped taking your thyroid hormone tablets in preparation for your treatment. Your nurse will tell you when you should start to take them again. Usually, this is 2 to 3 days after your treatment.
You will need to take thyroxine tablets to replace the hormones that your thyroid gland normally makes. Your doctors will want to keep your thyroid hormones at a slightly higher level than you would normally need. This is to stop your body producing another hormone called thyroid stimulating hormone . TSH can help some types of thyroid cancer cells to grow.
The doctors will work out the correct dose for you and when to start taking it.
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Plan For Transportation After Treatment
Radioactive iodine gives off radiation. This means that after your treatment, you wont be able to go home using public transportation such as buses, the subway, trains, or a plane. You can drive yourself home, have someone pick you up and take you home, or take a taxi or private car home. See our Resources section for information about car services.
Make a plan for getting home before you come for your treatment.
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.
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How Are Thyroid Nodules Treated
Treatment depends on the type of thyroid nodule. Treatment options include:
- No treatment/watch and wait: If the nodules arent cancerous, you and your healthcare provider may decide that you dont need to be treated at this time. Youll see your provider regularly so they can check for any changes in the nodules.
- Radioactive iodine: Your provider may use radioactive iodine to treat hyperfunctioning thyroid nodules and goiters with several nodules. Your thyroid gland absorbs the radioactive iodine, causing the nodules to shrink.
- Surgery: Surgery to take out the nodules is the best treatment for nodules that are cancerous, cause obstructive symptoms like breathing or swallowing issues and are suspicious (they cant be diagnosed without being surgically removed and examined.
What Are The Special Concerns For Men
Men who receive RAI treatment for thyroid cancer may have decreased sperm counts and temporary infertility for periods of roughly two years. Sperm banking is an option in a patient who is expected to need several doses of RAI for thyroid cancer.
Instructions to reduce exposure to others after I-131 RAI treatment
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What Is Radioiodine Ablation
Radioactive iodine therapy can destroy either all or part of your thyroid gland, depending on what is needed to alleviate your . In some cases, it is not necessary to have the entire thyroid gland rendered nonfunctional. In most cases, though, the whole gland will need to be destroyed.
Your doctor may refer to radioactive iodine therapy as radioactive iodine ablation or radioiodine ablation. Ablation is a term that refers to destruction or erosion.
Here is what you might expect when undergoing radioactive iodine therapy, starting with how your doctor will determine what dose will be necessary to treat your particular case of hyperthyroidism.
Are There Permanent Side Effects From Radioactive Iodine Therapy
It is highly likely that this procedure will destroy some or most of your thyroid gland. Since hormones produced by the thyroid are essential for metabolism, most patients will need to take thyroid pills for the rest of their life following the procedure. Thyroid pills are inexpensive, and patients will typically be prescribed one pill per day. There are essentially no other permanent side effects from the procedure. The risk of cancer from this therapy is very small.
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Iii Cellular Effects Of Radiation
Ionizing radiation has profound effects on living cells. In high doses, it leads to genetic damage, mutations, or cell death. At all times, living organisms have been exposed to potentially harmful radiation from natural sources such as sunlight and cosmic radiation. In addition, the intracellular aerobic metabolism produces reactive oxygen species and lipid peroxidation. Thus, it has been estimated that 109 free radicals are produced in every cell each day due to the endogenous oxygen turnover, mainly by the mitochondria . Exogenous and endogenous antioxidants to a high degree protect against the damaging effects of these reactive species. Nevertheless, mammalian cells undergo about 10,000 measurable DNA modification events per cell per hour, in part due to the spontaneous hydrolysis of nucleotide residues . To maintain DNA integrity and gene function, the organism is armed with a variety of strategies to respond to and repair these damages. Thereby, the number of persistent DNA changes declines to less than 100 per cell per day, and apoptosis and immunological responses reduce the number of persistent mutations even further . DNA damage escaping this array of defense mechanisms is carcinogenic and constitutes a main feature of cell aging.
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 .
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Who Should Take Ki
Since children are at the highest risk to exposure to radioactive iodine, KI should be available to all of them. Because of the risk to the fetus, pregnant women should also take KI in the event of a nuclear accident. Adults are at a lower risk but still may benefit from KI. In addition to KI, priority should be given to evacuation, sheltering and avoiding contaminated food, milk, and water. KI should not take the place of any other protective measure.
Clearing The Radioactive Iodine From Your Body
Some of the radioactive iodine will be taken up by your thyroid cells, but there will be some left over. Most of the extra radioactive iodine will leave your body through your urine , and smaller amounts will leave your body in your saliva , sweat, and bowel movements .
Follow these guidelines to help the radioactive iodine leave your body quickly.
- Drink lots of liquids. Starting right after your treatment, try to drink at least 1 cup of low-iodine liquid every hour while youre awake. Keep doing this for 2 to 3 days after your treatment. You dont have to wake up at night to drink liquids.
- Your urine will be radioactive so urinate as much as you can to empty your bladder. Try not to get urine outside of the toilet. If you do get urine outside of the toilet, wear gloves and clean up it up with an all-purpose cleaning disinfectant. If you normally stand while urinating, sit for 2 days after your treatment unless your healthcare provider gives you other instructions. This is so you can avoid getting urine anywhere but the toilet. Try to urinate every time you feel the urge instead of holding it in your bladder.
- Your bowel movements will also be radioactive. Go to the bathroom as much as you can so your bowel movements dont stay in your colon.
- If youre often constipated , ask your doctor about taking laxatives before your treatment. If you dont have a bowel movement within 24 hours after your treatment, call your doctor.
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Radiation Therapy For Thyroid Cancers
Doctors at NYU Langone may prescribe radiation therapyin which energy beams are used to destroy cancer cellsin people with advanced thyroid cancer that does not respond to radioactive iodine therapy.
NYU Langone doctors may use external beam radiation therapy, which uses a machine called a linear accelerator. External beam radiation therapy is typically given after surgery for thyroid cancers that do not absorb radioactive iodine, including many forms of cancer that have spread.
External beam radiation therapy can help destroy any remaining thyroid cancer cells, including those that have spread to lymph nodes in the neck or other parts of the body, such as the lungs or liver. This form of radiation may also be used to treat these forms of thyroid cancer in people who cannot have surgery due to poor health.
How Radioactive Iodine Works
Radioactive iodine is available orally as a pill or liquid, so you will not need to be hospitalized to take it. After you take the pill, your doctor will recommend drinking lots of fluids to prompt the release of the radioactive iodine through your urine.
Fortunately, radioactive iodine therapy is targeted to treat only your thyroid gland. Thyroid cells are the main cells in the body that can absorb iodine, so there is very little radiation exposure to the rest of your body’s cells. When the thyroid cells absorb the radiation, they are damaged or destroyed.
Approximately 90% of people who take radioactive iodine to treat hyperthyroidism need only one dose, although it may take up to 6 months for it to fully work. Fortunately, most patients experience reduced symptoms about a month after treatment.
If your overactive thyroid symptoms persist 6 months after treatment, you may need a second dose. In very rare cases, a person may still not see a benefit after a second dose of radioactive iodine. In these cases, may be needed instead.
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How Does Radioactive Iodine Treat Thyroid Cancer
The most common types of thyroid cancer can usually be treated with large doses of radioactive iodine. The therapy is usually given after removal of the thyroid gland to destroy any remaining thyroid tissue.
A tracer dose of radioactive iodine can also be used to track remaining thyroid tissue and/or cancer that could have spread to other parts of the body. These tests show if iodine concentrates in areas that contain thyroid cancer, and whether large amounts of RAI are needed to destroy the tumor implants.
What To Do After Radioactive Iodine Treatment
In the days following radioactive iodine therapy, you will need to take certain precautions to prevent exposing other people to radiation. Keep in mind that the precautions listed below are general your doctor will be able to provide more specific advice tailored to your individual needs and medical circumstances.
You will need to:
Avoid public places and stay a safe distance away from others for the first 3 days after treatment . Drink plenty of water during this time to encourage the removal of radioactive iodine through your urine.
Do not share items with anyone else for the first 3 days after treatment. Do your laundry and dishwashing separately. Wipe the toilet seat after each use. Wash your hands often, and shower each day.
Sleep alone for 3 to 5 nights after treatment, depending on the strength of your dose.
Avoid personal contact with children such as hugging or kissing for 3 to 7 days, depending on the strength of your dose.
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Associated Endocrinologists And Thyroid Nodules
At Associated Endocrinologists, we are proud to be one of the leading endocrinology practices in the United States and one of only a few practices in Michigan to offer thyroid radiofrequency ablation for treating thyroid nodules.
If you have symptoms of thyroid dysfunction or believe you have developed a thyroid nodule, call us at and schedule a consultation today.
Adverse Effect Of I131 Therapy
The common acute side effects in the gastrointestinal tract are heartburn, nausea, diarrhea, and vomiting.
The acute adverse effects of RAI therapy include radiation-induced thyroiditis that is associated with neck pain thyroid swelling and transient thyrotoxicosis. Thyroid swelling may appear after a few days following the therapy. The symptoms can be managed by nonsteroidal antiinflammatory drug. Early after RAI therapy, even though the goiter volume and the impact on the respiratory function remain unchanged , the critical thyroid swelling and respiratory distress can be experienced, fortunately it is a rare complication . If the presence of tracheal compression is previously known, especially in large goiter patients, 25 mg prednisolone may be given daily for 14 days to prevent thyroid swelling from RAI therapy .
Transient thyrotoxicosis, a transient elevation of the thyroid hormone levels, can be practiced due to the secretion of stored hormones from the thyroid gland. Thyroid storm or thyrotoxicrisis is a rare but severe and potentially life-threatening hypermetabolic condition induced by excessive release of thyroid hormones. The treatment must include i.v. infusion of ATDs, steroids, and beta-blockers to avoid a fatal outcome.
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What Is The Proof That Ki Works
After the 1986 Chernobyl nuclear accident, shifting winds blew a radioactive cloud over Europe. As many as 3,000 people exposed to that radiation developed thyroid cancer over the next 10 years. Most victims had been babies or young children living in Ukraine, Belarus, or Russia at the time of the accident. The region of excess risk extended up to a 200 mi radius from Chernobyl. Poland, immediately adjacent to Belarus and Ukraine, distributed KI to > 95% of their children within 3 days of the accident and did not appear to have an increase in thyroid cancer during the first 3 years of clinical follow up.
Ii The Story Of 131i Therapy
In 1895, it was discovered that iodine was a constituent of the thyroid gland, and 20 yr later it was demonstrated that the gland could take up iodine actively. In 1923, Henry Plummer introduced iodine as adjunctive treatment to surgery, which was at that time the only treatment for Graves’ disease. Soon thereafter, iodine became an important component in the treatment of Graves’ disease. György Hevesy established, also in 1923, the principle of using radioactive substances to assess biological processes, but further research in that field was limited by the lack of naturally occurring radioactive substances. A breakthrough came in 1934 when Enrico Fermi described the artificial production of 22 new radioactive elements, among these iodine isotopes, by irradiating aluminum foil with an -emitting source.
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