Treatment with radioactive iodine is sometimes the only chance of saving a person suffering from a different form of( papillary or follicular) differentiated thyroid cancer.
The main goal of radioiodine therapy is the destruction of follicular cells of the thyroid gland. However, not every patient can receive a referral to this type of treatment, which has a number of indications and contraindications.
What is radioiodine therapy, in what cases is it used, how should it be prepared and in which clinics can treatment be administered? All of these questions can be found in our article.
The concept of the
method Radioiodine is used radioactive iodine( in the medical literature it can be called iodine-131, radioiodine, I-131) - one of the thirty-seven isotopes to all of us known iodine-126, available in virtually every medicine chest.
Having a half-life of eight days, radioiodine spontaneously disintegrates in the patient's body. This leads to the formation of xenon and two types of radioactive radiation: beta and gamma radiation.
The equally high penetrating power of gamma particles allows them to easily pass through any tissues of the patient's body. For their registration high-tech equipment is used - gamma cameras. Not producing any curative effect, gamma radiation helps to detect places of localization of radioiodine accumulations.
Having scanned the patient's body in a gamma camera, the specialist easily identifies the foci of accumulation of a radioactive isotope.
This information is of great importance for the treatment of patients suffering from thyroid cancer, since luminous foci that appear in their bodies after a course of radioiodine therapy, allow to draw a conclusion about the presence and location of metastases of malignant neoplasm.
The main goal of treatment with radioactive iodine is complete destruction of the tissues of the affected thyroid gland.
The therapeutic effect, occurring two to three months after the initiation of therapy, is akin to the result obtained with the surgical removal of this organ. Some patients with recurrence of pathology may be assigned a second course of radioiodine therapy.
Indications and contraindications
Radioiodine therapy is prescribed for the treatment of patients suffering from:
- Hyperthyroidism is an ailment caused by an increased activity of the thyroid gland, accompanied by the appearance of small benign nodular neoplasms.
- Thyrotoxicosis - a condition caused by an overabundance of thyroid hormones, which is a complication of the aforementioned ailment.
- All types of thyroid cancer characterized by the appearance of malignant neoplasms in the tissues of the affected organ and accompanied by the attachment of an inflammatory process. Treatment with radioactive iodine is especially necessary for patients with distant metastases that have the ability to selectively accumulate this isotope. The course of radioiodine therapy with respect to such patients is carried out only after a surgical operation to remove the affected gland. With the timely use of radioiodine therapy, most patients with thyroid cancer can cure completely.
Radioiodine therapy has proved its effectiveness in the treatment of Graves' disease, as well as nodal toxic goiter( otherwise referred to as functional thyroid autonomy).In these cases, treatment with radioactive iodine is used instead of a surgical procedure.
The use of radioiodine therapy is especially justified in the case of a recurrence of the pathology of an already operated thyroid gland. Most often, such relapses occur after operations to remove diffuse toxic goiter.
Given the high probability of postoperative complications, specialists prefer to use the tactics of treatment with radioiodine.
Absolute contraindication to the appointment of a radio-therapy is:
- Pregnancy: exposure to radioactive iodine on the fetus can provoke the malformations of its further development.
- Breastfeeding period of a baby. Breastfeeding mothers receiving treatment with radioactive iodine, it is necessary for a fairly long time to wean the baby from the breast.
Advantages and disadvantages of the
procedure The use of iodine-131( compared to surgical removal of the affected thyroid gland) has a number of advantages:
- It does not involve the need to introduce the patient into anesthesia.
- Radiotherapy does not require a rehabilitation period.
- After treatment with the isotope, the patient's body remains unchanged: no scars and scars( unavoidable after the operation), disfiguring the neck, do not remain on it.
- Laryngeal edema and unpleasant sore throat, developing in the patient after taking a capsule with radioactive iodine, can be easily eliminated with topical preparations.
- Radioactive radiation associated with the intake of an isotope is localized primarily in the tissues of the thyroid gland - it does not extend to the remaining organs.
- Since repeated surgery for a malignant thyroid tumor can pose a threat to the life of the patient, radioiodine therapy, which can completely reverse the effects of relapse, is an absolutely safe alternative to surgery.
At the same time, radioiodine therapy has an impressive list of negative aspects:
- It can not be used in relation to pregnant women. Nursing mothers are forced to stop breastfeeding their children.
- Given the ability of ovaries to accumulate a radioactive isotope, it is necessary to protect themselves from pregnancy during six months after the completion of therapy. In connection with the high probability of violations associated with the normal production of hormones necessary for the proper development of the fetus, the appearance of offspring should be planned only two years after the application of iodine-131.
- Hypothyroidism, inevitably developing in patients undergoing radioiodine therapy, will require long-term treatment with hormonal drugs.
- After the application of radioiodine, there is a high probability of autoimmune ophthalmopathy leading to a change in all soft tissues of the eye( including nerves, fatty tissue, muscles, synovial membranes, fat and connective tissues).
- A small amount of radioactive iodine accumulates in the tissues of the mammary glands, ovaries and prostate.
- The effect of iodine-131 is capable of provoking a narrowing of lacrimal and salivary glands with subsequent changes in their functioning.
- Radioiodine therapy can lead to significant weight gain, the appearance of fibromyalgia( severe muscle pain) and unreasonable fatigue.
- Against the background of treatment with radioactive iodine, there may be an exacerbation of chronic diseases: gastritis, cystitis and pyelonephritis, patients often complain about changes in taste, nausea and vomiting. All these conditions are short-lived and are amenable to symptomatic treatment.
- The use of radioactive iodine increases the likelihood of developing a malignant tumor of the small intestine and thyroid gland.
- One of the main arguments of opponents of radio-therapy is the fact that the thyroid gland, destroyed as a result of the action of the isotope, will be lost forever. As a counterargument, one can argue that after surgical removal of this organ, its tissues are also not subject to recovery.
- Another negative factor of radioiodine therapy is the need for a three-day strict isolation of patients who took a capsule with iodine-131.Since their body then begins to allocate two types( beta and gamma) of radioactive radiation, during this period, patients become dangerous to others.
- All clothing and objects used by the patient undergoing treatment with radioiodine are subject to either special treatment or disposal in compliance with radioactive protection measures.
What is better, surgery or radioactive iodine?
Opinions on this score are contradictory, even among specialists involved in the treatment of thyroid diseases.
- Some of them believe that after a thyroidectomy( a surgical operation to remove the thyroid gland), a patient taking estrogen-containing medications can lead a perfectly normal life, since regular admission of thyroxin can compensate for the function of the missing gland without causing side effects. The supporters of radioiodine therapy emphasize that this type of treatment completely eliminates side effects( the need for anesthesia, removal of parathyroid glands, damage to the recurrent laryngeal nerve) that are unavoidable in performing a surgical operation. Some of them even cunning, claiming that radioiodine therapy will lead to euthyroidism( normal thyroid gland functioning).This is an extremely erroneous statement. In fact, radioiodine therapy( as well as the operation of thyroidectomy) is aimed at achieving hypothyroidism - a condition characterized by complete suppression of the thyroid gland. In this sense, both methods of treatment pursue completely identical goals. The main advantages of treatment with radioiodine are complete painlessness and non-invasiveness, as well as the absence of risk of complications arising after surgery. Complications associated with exposure to radioactive iodine, in patients, as a rule, is not observed.
So which technique is better? In each specific case, the last word remains with the attending physician. In the absence of contraindications to the appointment of radioiodine therapy in a patient( suffering, for example, Graves' disease), he most likely will advise to prefer it. If the doctor believes that it is more appropriate to perform a thyroidectomy operation, you need to listen to his opinion.
Preparation for isotope preparation is necessary two weeks before the start of treatment.
- It is advisable not to let iodine get on the surface of the skin: patients are forbidden to lubricate with iodine wounds and apply iodine mesh to the skin. Patients should refrain from visiting the salt room, bathing in sea water and inhaling the sea air, saturated with iodine. Residents of sea coasts need isolation from the environment at least four days before the start of therapy.
- Vitamin complexes, food additives and medications containing iodine and hormones are strictly prohibited: should be withdrawn from their admission four weeks before radioiodine therapy. A week before the reception of radioactive iodine, all drugs prescribed for the treatment of hyperthyroidism are canceled.
- Women of childbearing age are required to make a pregnancy test: is necessary to avoid the risk of pregnancy.
- Before the procedure for taking a capsule with radioactive iodine, a test is carried out for the absorption of radioactive iodine by the tissues of the thyroid gland. If the gland was removed operatively, a test is performed for sensitivity to iodine in the lungs and lymph nodes, since they take on the function of iodine accumulation in such patients.
Diet in front of
The first step in preparing a patient for radioiodine therapy is to observe a low-level diet aimed at reducing the iodine content in the body in every possible way so that the effect of the radioactive drug will bring a more tangible effect.
The appointment of a diet low in iodine requires an individual approach to each patient, therefore the recommendations of the doctor in each case are of decisive importance.
A low-diode diet does not mean that the patient should give up salt. It should only be used neiodirovanny product and limit its amount of eight grams per day. The diet is called a low-yield because the use of foods with a low( less than 5 μg per serving) content of iodine is still allowed.
Patients undergoing radioiodine therapy should completely discontinue use:
- Seafood( shrimps, crab sticks, sea fish, mussels, crabs, seaweed, sea cabbage and bioadditives created on their basis).
- All kinds of dairy products( sour cream, butter, cheese, yoghurt, dried milk porridge).
- Ice-cream and milk chocolate( a small amount of dark chocolate and cocoa powder is allowed to be included in the patient's diet).
- Salted nuts, instant coffee, chips, meat and fruit canned food, French fries, eastern dishes, ketchup, salami, pizza.
- Dried apricots, bananas, cherries, apple puree.
- Iodized eggs and dishes with lots of egg yolks. This does not apply to the consumption of egg whites that do not contain iodine: during the diet, they can be used without any restrictions.
- Dishes and products, painted in different shades of brown, red and orange, as well as medicines containing food colors of similar colors, since many of them can include iodine-containing dye E127.
- Factory-made bakery products containing iodine;corn flakes.
- Soy products( cheese tofu, sauces, soy milk), rich in iodine.
- Green parsley and dill, leaf and watercress.
- Cauliflower, zucchini, persimmon, green pepper, olives, potatoes baked in "uniform".
During the period of a low one-week diet, the following is allowed:
- Peanut butter, unsalted peanuts, coconut.
- Sugar, honey, fruit and berry jams, jellies and syrups.
- Fresh apples, grapefruits and other citrus fruits, pineapples, musk melons, raisins, peaches( and juices from them).
- White and brown rice.
- Egg noodles.
- Vegetable oils( with the exception of soybean oil).
- Raw and freshly prepared vegetables( except potatoes in peel, beans and soybeans).
- Frozen vegetables.
- Poultry meat( chicken, turkey).
- Beef, veal, meat of lamb.
- Dried herbs, black pepper.
- Cereals, pasta( in limited quantities).
- Carbonated soft drinks( lemonade, diet coke, not containing erythrosine), tea and well filtered coffee.
Treating iodine with thyroid thyroid
This type of treatment is one of the most effective procedures, the distinguishing feature of which is the use of a small amount of radioactive material selectively accumulating in those areas that require therapeutic treatment.
It has been proved that, in comparison with remote radiation exposure( with comparable dosage of exposure), radioiodine therapy can create a dose of radiation in the tissues of the tumor focus, which is fifty times higher than the radiotherapy, while the effect on bone marrow cells and the structure of bones and muscles turned out to betens times smaller.
Selective accumulation of radioactive isotope and shallow penetration of beta particles into the thickness of biological structures provides the possibility of a targeted effect on the tissue of tumor sites with their subsequent destruction and complete safety in relation to adjacent organs and tissues.
How does the procedure of radioiodine therapy? During the session, the patient receives a gelatin capsule of normal size( devoid of smell and taste), inside of which is radioactive iodine. The capsule should be swallowed quickly with a large amount of water( at least 400 ml).
Sometimes a patient is offered radioactive iodine in liquid form( usually in vitro).After taking such a drug, the patient will have to thoroughly rinse his mouth, swallowing the water then used for this. Patients using removable dentures before the procedure will be asked to remove them.
In order for the radioiodine to absorb better, providing a high therapeutic effect, the patient should refrain from eating and drinking any drinks for an hour.
After taking the capsule, the radioactive iodine begins to accumulate in the tissues of the thyroid gland. If it was surgically removed, the isotope accumulation takes place either in the tissues that remain from it, or in partially altered organs.
Excretion of radioiodine occurs through fecal masses, urine, secret of sweat and salivary glands, respiration of the patient. That is why the radiation will settle on the objects of the environment surrounding the patient. All patients are warned in advance that a limited number of things should be taken to the clinic. Upon admission to the clinic, they are obliged to change into hospital clothes and clothes given to them.
After taking radioiodine, patients in an isolated box must strictly observe the following rules:
- When cleaning teeth, avoid splashing water. The toothbrush should be thoroughly rinsed with water.
- When you visit the toilet, you must use the toilet carefully, avoiding spattering of urine( for this reason, men should urinate only sitting).It is necessary to wash urine and feces at least two times, after waiting for the filling of the tank.
- All cases of accidental splashing or discharge should be reported to a nurse or nurse.
- During vomiting, the patient should use a polyethylene bag or toilet bowl( flush vomit twice), but in no case - not a shell.
- It is forbidden to use reusable handkerchiefs( there should be a stock of paper handkerchiefs).
- The used toilet paper is washed off with feces.
- The entrance door should be kept closed.
- The remains of food are put in a plastic bag.
- Feeding birds and small animals through the window is strictly prohibited.
- Shower intake should be daily.
- In the absence of a chair( it should be daily), it is necessary to inform the nurse: the attending physician will prescribe a laxative.
To a patient in strict isolation, visitors( especially small children and pregnant women) are not allowed. This is done in order to prevent their radiation contamination with a beta-and gamma-particle stream.
Treatment procedure after ectomy of the thyroid
Radioiodine therapy is often prescribed for cancer patients who have undergone a thyroid removal operation. The main goal of such treatment is the complete destruction of abnormal cells, which could remain not only in the region of the site of the removed organ, but also in the blood plasma.
Patients treated with radioactive iodine are required to:
- Increase the amount of liquid to drink in order to accelerate the removal of iodine-131 decay products from the body.
- As often as possible take a shower.
- Use personal hygiene items.
- Using the toilet, double pull off the water.
- Change your underwear and bedding every day. Since the radiation can be removed with the help of washing, the patient's clothes can be washed with the clothes of the rest of the family.
- Avoid close contact with young children: take them in your arms and kiss. Stay close to the kids should be as small as possible.
- Within three days after discharge( it is carried out on the fifth day after taking the isotope), sleep only alone, apart from healthy people. To enter into sexual contact, and also to be near to the pregnant woman it is authorized only in a week after an extract from clinic.
- If a patient recently undergoing treatment with radioactive iodine is urgently hospitalized, he must inform the medical staff about this, even if the radiation was carried out in the same clinic.
- All patients who underwent radioiodine therapy will take life-long thyroxin and visit the endocrinologist's office twice a year. In all other respects, the quality of their life will be the same as before the treatment. The above limitations are of a short-term nature.
Radioiodine therapy can cause certain complications:
- Sialadenitis is an inflammatory disease of the salivary glands of , characterized by an increase in their volume, densification and soreness. The impetus to the development of the disease is the introduction of a radioactive isotope in the absence of a distant thyroid gland. In a healthy person, the cells of the thyroid gland would be activated, seeking to eliminate the threat and absorb radiation. In the body of the operated human, this function is performed by the salivary glands. The progression of sialadenite occurs only when the radiation dose is high( above 80 millicuries-mCi).
- Various disorders of the reproductive function of , but this reaction of the body occurs only due to multiple exposures with a total dosage exceeding 500 mCi.
Several years ago I suffered severe stress, after which I was exposed to a terrible diagnosis - toxic diffuse goiter, or Graves' disease. The palpitation was such that I could not sleep. Because of the constantly experienced heat, I walked around the whole winter in a T-shirt and a light jacket. His hands were shaking, and he was in great distress. Despite a good appetite, I lost a lot of weight and all the time I felt tired. And - to top it all off - a goiter appeared on his neck. Huge and ugly. I tried a lot of medicines, went through the sessions of acupuncture and oriental massage. Appealed even to psychics. There was no sense. In complete despair I decided on radioiodine therapy. The treatment was held in the Warsaw clinic. The whole procedure took two days. On the first day I passed the tests and the test for the capture of the isotope. In the morning of the next day, a scintigraphy procedure was performed. Summarizing the results of the studies, the doctor prescribed a dose of radioiodine equal to 25 mCi. The radiotherapy session was very quick: a capsule was removed from the container with a radioactivity icon using a plastic tube. I was asked to take a sip of water from a disposable cup and stick out my tongue. After the capsule was on my tongue( I did not touch anything with my hands), I was given water again. Shaking my hand and wishing health, the doctor let me out of the office. The procedure was completed. I have not experienced any special sensations. The next morning, my throat ached a little. A couple of hours later it passed. The next day, the appetite decreased slightly. Ten days later I felt the first signs of better health. The pulse slowed down, strength began to come, the goiter began to diminish just before our eyes. Eight weeks after radioiodine therapy, the neck again became thin and beautiful. The analysis was normalized after six weeks. From the thyroid gland now no problems, I feel quite healthy person.
- Citizens of the Russian Federation who have a compulsory medical insurance policy and who need treatment with radioactive iodine are entitled to a free quota. First it is necessary to contact( using an e-mail or by phone) with one of the medical institutions that have a radiological department and find out whether they can take a certain patient for treatment.
Having familiarized themselves with the package of medical documents( for their consideration it takes two to three days), leading specialists of the medical institution make a decision about the expediency of issuing quotas. As practice shows, the chances of obtaining a quota by the end of the year are extremely small, so do not plan treatment for this period.
Having received a refusal in one clinic, do not despair. All medical institutions where radioiodine therapy is administered should be called. Having shown a certain persistence, you can achieve a quota.
- A completely different situation is observed in case the patient is able to pay for his treatment. Unlike patients who are forced to queue for a free quota and who do not have the right to choose a medical institution, a person who pays for a course of radioiodine therapy can pass it at any clinic he likes.
The cost of radioiodine therapy is determined based on the level of the medical institution, the qualifications of the specialists working in it and the dosage of radioactive iodine.
For example, the cost of treatment in Obninsk Radiological Center is as follows:
- A patient receiving a radioiodine in a dosage equal to 2 GBq( gigabecquerels) and placed in a single room, will pay 83,000 rubles for treatment. Accommodation in a double room will cost him 73 000 rubles.
- If the dosage of radioiodine was 3 GBq, treatment with a stay in a single room will cost 105,000 rubles;in a double room - 95 000 rubles.
Of course, all quoted prices are approximate. Clarify the information on the cost of treatment is necessary in conversation with the responsible staff of the medical institution.
Where is radioiodine therapy treated in Russia?
A number of Russian clinics can undergo a course of radioactive thyroid therapy in a number of Russian clinics:
- in the Moscow Federal State Budgetary Institution "Russian Research Center for Roentgenology";
- in the Arkhangelsk "Northern Medical Clinical Center named after N.A.Semashko ";
- in the Kazan Nuclear Medicine Center;
- in Obninsk "Medical Radiological Research Center. A.F.Tsyba ";
- in the radiological department of the "City Clinical Hospital No. 13", located in Nizhny Novgorod;
- in the radiological department of the Omsk Regional Clinical Hospital;
- in the Krasnoyarsk "Center for Nuclear Medicine of the Siberian Clinical Center of the FMBA of Russia".