Side Effects Of Radiation Therapy
Radiation doesn’t only work during individual treatment sessions. Cells that are impacted by radiation at the time of treatment can take daysâor even monthsâto die off completely. In most cases, this cell death, as well as damage to surrounding tissues, is what causes the side effects from radiation therapy.
Fatigue, hair loss, and skin changes are common side effects of radiation therapy, but you can also have other side effects depending on the part of your body where treatment is targeted.
External Beam Radiation Therapy For Thyroid Cancer
External beam radiation therapy uses high-energy rays to destroy cancer cells or slow their growth. A carefully focused beam of radiation is delivered from a machine outside the body.
This type of radiation therapy is most often used to treat medullary thyroid cancer and anaplastic thyroid cancer. For cancers that take up iodine radioiodine therapy is usually a better treatment.
External beam radiation therapy is often used for cancers that don’t take up iodine and have spread beyond the thyroid. This might be done to help treat the cancer or to lower the chance of cancer coming back in the neck after surgery.
If a cancer does not respond to radioiodine therapy, external radiation therapy may be used to treat cancer that has come back in the neck or distant metastases that are causing pain or other symptoms.
External beam radiation therapy is usually given 5 days a week for several weeks. Before your treatments start, the medical team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. The treatment itself is painless and much like getting a regular x-ray. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment usually takes longer.
How Thyroid Cancer Is Treated
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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Side Effects Of Rai Treatment
Usually, being temporarily radioactive is the only major side effect of RAI treatment. Drinking lots of water helps the RAI treatment pass out of your body faster and also reduces the bladders exposure to radiation.
Because the salivary glands may absorb some iodine, you might have a dry mouth as well as taste and smell changes for a few weeks after treatment. Some people will have ongoing problems with swelling and pain in their salivary glands. Ask your treatment team for medicines to relieve swelling and pain. Other side effects, such as tiredness, are often caused by thyroid hormone withdrawal, but will improve when your thyroid hormone levels return to normal.
Discuss Your Treatment Plan
Your doctor will discuss your treatment plan with you.
Your treatment plan will follow these steps that will take place over a few days:
1. On the first day, youll have blood tests. After those tests, youll see your doctor and get a thyrotropin alfa injection to help you get ready for your treatment. This injection will help any leftover thyroid tissue absorb the radioactive iodine.
2. On the second day, youll get another thyrotropin alfa injection. Then youll get a small diagnostic dose of radioactive iodine in a pill. You wont have to follow any precautions after getting this small diagnostic dose of radioactive iodine. After you take this pill, youll have a whole-body scan. This scan will show your doctor how the radioactive iodine is being taken up in your body.
3. On the third day, youll have your full dose of radioactive iodine treatment. This is an outpatient procedure, so you wont be admitted to the hospital.
4. Youll have another whole-body scan several days after your treatment. This helps your doctor see where the dose of radioactive iodine was taken up in your body.
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Effects Of Thyroid Cancer Treatment
Cancer treatment is geared toward positive outcomes, such as removing the cancer, reducing tumor size, preventing recurrence and cure. However, many of the treatments used to accomplish that have their own challenges for our bodies. Prior knowledge of what to expect helps in treatment decision-making and getting the support you need to deal with these effects.
Fatigue: The most common effect of cancer treatment, this fatigue is different than the kind healthy people experience. It can result from any type of cancer treatment.
Pain: Tumors, surgery, and other treatments can all cause pain with cancer
Chemotherapy Side Effects:
- Low Blood Counts: Many chemotherapy drugs can cause red and white blood cells to be low, resulting in a high risk for infection and anemia.
- Nausea and Vomiting: Siteman has considerable experience managing these so cancer therapy can continue and you can live your normal life.
- Peripheral Neuropathy: Chemotherapy-induced peripheral neuropathy is a set of symptoms caused by damage to the nerves that control the sensation of our hands and feet, causing numbness, tingling and pain.
Your doctors office should have a fact sheet on the usual side effects of your specific type of treatment and their approach to dealing with them.
Sleep Disorders: More common in people with cancer, sleep may be disturbed by the cancer, pain, or certain drugs or treatments.
If Youre Getting Radiation Therapy To The Abdomen
If you are getting radiation to your stomach or some part of the abdomen , you may have side effects such as:
Eating or avoiding certain foods can help with some of these problems, so diet planning is an important part of radiation treatment of the stomach or abdomen. Ask your cancer care team about what you can expect, and what medicines you should take to help relieve these problems. Check with your cancer care team about any home remedies or over-the-counter drugs youre thinking about using.
These problems should get better when treatment is over.
Managing nausea
Some people feel queasy for a few hours right after radiation therapy. If you have this problem, try not eating for a couple of hours before and after your treatment. You may handle the treatment better on an empty stomach. If the problem doesnt go away, ask your cancer care team about medicines to help prevent and treat nausea. Be sure to take the medicine exactly as you are told to do.
If you notice nausea before your treatment, try eating a bland snack, like toast or crackers, and try to relax as much as possible. See Nausea and Vomiting to get tips to help an upset stomach and learn more about how to manage these side effects.
Managing diarrhea
Many people have diarrhea at some point after starting radiation therapy to the abdomen. Your cancer care team may prescribe medicines or give you special instructions to help with the problem. Diet changes may also be recommended, such as:
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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.
Pregnancy And Radioactive Iodine Therapy
Dont get pregnant or get your partner pregnant for at least 6 months after getting radioactive iodine therapy, or as long as your doctor tells you to. Use birth control after treatment for at least 6 months after getting this treatment. If youre planning to have a child, talk with your doctor about your plans before your treatment.
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Treatment Options By Stage
Almost all thyroid cancers are treated with surgery. If the thyroid cancer is only within the tissues of the neck, both in the thyroid gland and in the lymph nodes, surgery will typically be the first treatment. Patients with later-stage disease may be treated with surgery as well, but other treatments may be done first. Clinical trials may be recommended at any stage as a treatment option.
Hormone therapy and radioactive iodine therapy are only given for papillary, follicular, and Hurthle cell thyroid cancers. MTC and anaplastic thyroid cancers are not managed with radioactive iodine thyroid or thyroid hormone therapy.
Stage I: Surgery, hormone therapy, possible radioactive iodine therapy after surgery
Stage II: Surgery, hormone therapy, possible radioactive iodine therapy after surgery
Stage III: Surgery, hormone therapy, possible radioactive iodine therapy or external-beam radiation therapy after surgery
Stage IV: Surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. See below for more information, for “Metastatic thyroid cancer.”
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.
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This paper wont change the recommendation, but doctors and scientists accept randomized trials. So, I think it will change hearts and minds on this topic, he said. That should help doctors and patients feel more comfortable foregoing radiation after thyroid surgery, Leboulleux said. Ultimately, she thinks that will be good for patients.
Radiation is just one more worry for a patient. Once you know that you dont need it, I dont think you should receive it, Leboulleux said.
Radioactive iodine still helps for high-risk thyroid cancer, where the malignancy has already spread throughout the body. Whether follow-up radiation is beneficial for more intermediate-risk thyroid cancers is still an open question, Leboulleux added. That is something she hopes to investigate next.
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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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.
How To Cope With Side Effects Of Thyroid Cancer Treatment
Keep in mind that every patients experience is unique. With that said, here are some common thyroid cancer treatments, their potential side effects and some ways in which those side effects can be managed:
If youd like to learn more about managing the side effects of thyroid cancer treatments, you can speak with an oncologist in the Thyroid Clinic at Moffitt Cancer Center with or without a referral. To request an appointment, call or complete a new patient registration form online.
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Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
Preparing For Rai Therapy
For RAI therapy to be most effective, you must have a high level of thyroid-stimulating hormone in the blood. This hormone is what makes thyroid tissue take up radioactive iodine. If your thyroid has been removed, there are a couple of ways to raise TSH levels before being treated with RAI:
- One way is to stop taking thyroid hormone pills for several weeks. This causes very low thyroid hormone levels , which makes the pituitary gland to release more TSH. This intentional hypothyroidism is temporary, but it often causes symptoms like tiredness, depression, weight gain, constipation, muscle aches, and reduced concentration.
- Another way is to get an injection of thyrotropin , which can make withholding thyroid hormone for a long period of time unnecessary. This drug is given daily for 2 days, followed by RAI on the 3rd day.
Most doctors also recommend that you follow a low iodine diet for 1 or 2 weeks before treatment. This means avoiding foods that contain iodized salt and red dye #3, as well as dairy products, eggs, seafood, and soy.
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About Radioactive Iodine Treatment
Treatment with radioactive iodine lowers your risk of your thyroid cancer coming back. Its also used to treat thyroid cancer that spreads to other parts of your body.
Radioactive iodine is usually given in pill form, but it can also be given in liquid form if needed. Some people have trouble swallowing pills. If you do, tell your doctor in Molecular Imaging and Therapy Service before your treatment. This is sometimes called the Nuclear Medicine service.
Radioactive iodine enters your bloodstream and is taken up by any thyroid- like cells. The radioactivity destroys the cancer cells. The radioactive iodine gives off radiation nearby and destroys the cancer cells over time.
Risks And Side Effects
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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