Radioiodine therapy - treatment of diseases of the thyroid gland
Poor ecology, stress and other adverse conditions often lead to diseases of the thyroid gland. Its increase harms the body. Thyrotoxicosis can take many forms, including diffuse toxic goiter, also called Graves 'disease or Graves' disease. Sometimes it comes to thyroid cancer. Destroy the overgrown gland tissue and called radioactive iodine.
Diseases of the thyroid gland
Thyrotoxicosis, which is hyperthyroidism, can take various forms. These include diffuse and nodular toxic goiter, Plummer’s disease, Hashimoto goiter and some other ailments. These diseases are successfully treated with radioactive iodine (in Moscow it is carried out, for example, at the Central Research Institute of Radiological Research and Development and some other clinics). This method complements the treatment of many types of cancer and other tumors of the thyroid gland, including lymphoma and Hashimoto thyroiditis.
The opposite of thyrotoxicosis is hypothyroidism, which is not a serious threat and is corrected by drugs. In addition to diseases of the thyroid gland itself, sometimes there is a deficiency or hyperfunction of the parathyroid glands, i.e. hypoparathyroidism and hyperparathyroidism. Failure is treated with medication, but hyperfunction requires surgery.
Therapy for thyrotoxicosis and cancer
Most of these diseases effectively eliminate the treatment with radioactive iodine. This type of therapy is also being conducted in Moscow. Of course, conservative treatment of, say, toxic adenoma or diffuse toxic goiter with the help of medications is first prescribed. But efficiency rarely exceeds 40%, and often almost half. If such treatment does not produce results or there is a relapse, then the optimal solution would be to prescribe therapy with radioactive iodine I 131. You can also use radiation, but it increases the risk of cancer of the gland, and iodine remains harmless.
Cancer is removed promptly. But in this case, treatment with radioactive iodine in Moscow, as well as throughout the world, is carried out as an additional method of therapy. Here it is important to meet the deadlines after thyroidectomy and to carry out treatment according to the protocol, then the risk of metastasis can be minimized.
Why not an operation?
Sometimes an alternative to the treatment of thyrotoxicosis is surgery. Of course, the operation always carries a big risk, not to mention the fact that the scar on the skin is not a very aesthetic thing. Anesthesia itself, the risk of bleeding, the possibility of damage to the recurrent nerve are all factors that speak against the operation in favor of a more benign, but effective radio therapy. Of course, in some cases, without emergency measures simply can not do, as in the case of cancer.
When the surgical method is often retained part of the tissue to prevent hypothyroidism. However, this approach is fraught with relapses of the disease. Thyroid-stimulating autoimmune antibodies attack the remnants of the gland again, leading to a new round of disease. Therefore, now prefer to get the full therapeutic effect instead of temporary. Yes, and treatment with radioactive iodine cost is more acceptable.
Mild forms of the disease prefer to be treated with medication. Also, this method is started when problems arise in adolescents and children. In other cases, it is better to treat thyrotoxicosis with radioactive iodine. The drug has the form of a capsule or an aqueous solution.
By the way, in Europe, doctors generally trust more precisely to various antithyroid agents than to treatment with radioactive iodine. But in the US, radioiodine therapy is preferred as more effective. Of course, after it, it is necessary to undergo a rehabilitation program, but then taking medication also requires further restoration of the body.
Iodine radioisotopes were first introduced in 1941 in the United States. And since 1960, the method began to be used widely in medicine. Over the past period, they were convinced of its benefits, reliability and safety. Yes, and for the treatment of radioactive iodine price has become more affordable. In some clinics in America and Europe, treatment with small doses of iodine is already being conducted on an outpatient basis. We also allow this mode, but only for doses within 10.4 mCi for activity. Abroad, the norms are somewhat different, allowing for a stronger impact, which also has a positive effect on treatment.
The basis of the method
In medicine, the isotopes I 123 and I 131 are used. The first is for diagnosis, since it does not have a cytotoxic effect. But the second isotope allows treatment. It emits ß-and ɣ-particles. ß-radiation gives an irradiating effect localized in the tissues of the thyroid gland. ɣ-radiation allows you to control the dose and distribution of the drug. The thyroid gland accumulates this radioisotope of iodine I 131, and it, in turn, damages thyroid tissue, which is a therapy for thyrotoxicosis.
Safety for other tissues is due to the fact that the thyroid binds iodine isotopes and attracts them to itself. Moreover, its half-life is only 8 days. The intestinal and urinary systems capture, as a rule, the minimum of the isotope, not exceeding the permissible limits. The cytotoxic effect is obtained localized, destroying only thyrocytes, which leads to a decrease in the thyroid gland in volume and a transition to hypothyroidism without surgical intervention.
Hypothyroidism, in turn, is corrected by medication. L-thyroxine preparations are prescribed, which compensates for the necessary hormones, usually produced by the thyroid gland. Although this hormone is synthetic, it is practically not inferior to endogenous. Control of the level of hormones, no doubt, is necessary, sometimes the dosage must be changed, but otherwise the patients return to their normal lifestyle.
Now even our specialists are inclined to believe that it is necessary to conduct a single treatment with radioactive iodine in Moscow or other cities in order to trigger the development of hypothyroidism. Treatment with small doses simply reduces symptoms, removes the problem only for a time, which is not as effective as complete elimination. The dosage of the drug is calculated for each patient individually. This indicator depends on the volume of the gland, the severity of the disease, its stage, the absorption test and the scintigraphy routine.
First, a survey is performed, associated pathologies are specified, calculations are made. Sometimes it is decided to do two injections of the drug to achieve the desired result. But there are cases where surgery is more appropriate.
Cancer is also treated with radioactive iodine, but as a second stage of therapy. The dosages are higher, aimed at eliminating the risk of metastasis. The amount of the drug depends on the severity of the case and the extent of the process. This procedure is not performed on an outpatient basis, preferring to leave the patient for two or three days in the clinic.
Effects of taking the drug
You should be prepared for what will be after treatment with radioactive iodine. A few days after taking the drug, radioactive iodine will be released from the body through saliva and urine. These symptoms can last for different periods of time, depending on the age and the dose prescribed. At the same time, the elimination process in young people is accelerated compared with the situation in the elderly.
On the state of health is almost no effect. Only a few sensitive people who have been treated with radioactive iodine, reviews leave nausea during this period. It may also cause dry mouth or pain in the neck and throat. Note increased fatigue and metallic taste in the mouth. Sometimes it can affect the occurrence of constipation or diarrhea.
Limitations after treatment
But at the same time there are a number of limitations that are instructions for action. So, a certain period of time will need to avoid close contact with other people so as not to irradiate them. You will have to sleep alone, give up kisses and hugs, avoid sharing dishes and follow such measures. In this regard, a number of prescriptions can be distinguished according to the patient's behavior.
To patients undergoing treatment with radioactive iodine, the reviews confirm this; some time should be paid more attention to hygiene. So, it is better to flush the toilet twice, wash your hands after visiting it especially carefully in plenty of water and with soap. Separate crockery, towels, bed linen that no one else will use will be needed. Naturally, underwear and clothes should also be washed separately from the things of relatives. It is not necessary to prepare food for the household.
Even it is better to collect the garbage in a separate basket, and then return it to a medical institution for disposal (if such a service is provided). Otherwise, you can throw it in an ordinary garbage can after 8 days. The dishes should not be washed together with other people's objects; it is better to wash it by hand without a dishwasher. Disposable plates and appliances are placed in the same separate garbage bag.
Ladies and gentlemen!
Endocrinological center "Radioiodine therapy" welcomes you to our site!
We are a Russian company providing specialized medical services in the Russian Federation.
In particular, Endocrinological center "Radioiodine therapy" Our company organizes treatment of thyroid diseases radioactive iodine in Moscow, Estonia and Serbia (thyrotoxicosis and thyroid cancer), as well as diseases that are largely caused by endocrine system malfunction and metabolic functions in the body (type 1 and type 2 diabetes, obesity, overweight).
Before you is a site entirely dedicated to the possibilities. radio therapy (RJT) is currently the most promising method for treating a number of thyroid diseases. This method has been successfully used in world practice since 1960 and has proven its safety, efficiency, reliability and economy. In most cases, radioiodine therapy avoids thyroid surgery and all possible problems and troubles associated with its implementation (anesthesia, bleeding, damage to the recurrent nerve, parathyroid glands, scar on the skin).
First of all, radioactive iodine I 131 is used as a “method of choice” in the treatment of thyrotoxicosis and, in particular, its most common form - diffuse toxic goiter (DTZ), also known as graves disease or Basedow's diseaseas well as additional therapy thyroid cancer (thyroid cancer).
Of particular interest is the experience of the use of radioiodine therapy by the most developed countries from the point of view of science and medicine, and statistics and world experience only confirm the importance and significance of the method.
In detail about each of the diseases, techniques, about the procedure itself, you can read on the pages of our site.
What else can be useful for our site?
You can also learn in detail about the cost of treatment, diseases of the thyroid gland, and not only those that use radioiodine, but also other diagnoses related to thyroid activity. You will learn about places where you can get quality information and advice.
We consider it very important to be able to receive feedback from all of our patients and colleagues. Therefore, for your convenience, a feedback form was created on the page "Contacts", through which you can contact us, ask questions to our endocrinologists, and also send the necessary files.
In addition, in the section Online consultation of the endocrinologist You can get qualified advice from highly specialized endocrinological specialists:
- endocrinologist, specialist in nuclear medicine
- Surgeon doctor - endocrinologist (endocrinological department of surgery)
- endocrinologist (therapeutic department of the endocrinological profile)
- Endocrinologist, ultrasound specialist
and to make some of them and make an appointment through our website, using the service "Writing to the doctor online".
And, of course, we will be happy to hear from you.
Below, you can see residence map of our patients, when clicked, opens a large file format in a new window.
For citizens of the Russian Federation, the basic conditions for radioiodine therapy at the clinic are as follows:
- Help is provided free if the patient enters the program on regional quotas for the provision of high-tech medical care, according to the currently valid regulatory documents and within the framework of the approved standard.
- Each patient has the opportunity to receive additional diagnostic or therapeutic procedures that are included in the standard protocols of European clinics: application OFEK-CT, individual dosimetry, capsule form I131, accommodation in conditions of superior comfort, as well as a number of original medical techniques that are not available at European clinics.
- Medical assistance for a fee. You can pay for the services of the clinic by cash and cashless settlement.
Conditions of hospitalization in a radiological hospital
- For the course of radioiodine therapy for thyroid cancer, hospitalization in a closed-type radiological hospital is compulsory and is approximately from 3 to 6 days.
- It is important to understand that the period of stay in the hospital cannot be determined in advance, since it mainly depends on the rate of iodine isotope elimination from the body, which happens to each patient individually.
- During the inpatient stay, the patient is not provided with any additional examinations or consultations of other specialists, besides the attending physician, except for emergency care, in view of the current radiation safety standards.
- On the day of discharge, every patient is required to complete scintigraphy to determine the location and intensity of accumulation radioiodine.
The cost of treating thyroid cancer in the RCRCmakes 99 000 rubles.
Included in cost:
- Initial consultation endocrinologist in order to determine the indications and evaluation of contraindications to therapy with radioactive iodine. Selection of preparatory drug therapy,
- Superior Single Room,
- Three meals a day,
- Radio therapy with a medical package (determination of individual activity),
- Dose I131 (capsule of radioactive iodine),
- Round-the-clock duty of the medical service.
Memo to undergo therapy of the thyroid gland at the Center for X-ray Radiology.
Therapeutic treatment of the thyroid gland with radioactive iodine
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The work of the whole body depends entirely on the endocrine system. Its largest gland is the thyroid (thyroid gland). She is responsible for metabolic rate and growth.
The name was due to the proximity to the thyroid cartilage. Violations of her work occur 4-5 times more often in women, especially after menopause, which indicates a connection with the ovaries. After 45-50 years of age, the size and level of thyroid hormones all decrease.
It produces 2 hormones - calcitonin and thyroxin - T4. Its share is about 90%. From thyroxine, triiodothyronine or T3 is formed. These hormones are produced by the follicular cells of the thyroid gland.
Stimulation of their production is regulated by the hormone TSH of the pituitary gland, which stimulates the growth of gland cells (thyrocytes). Special cells (C) in the thyroid gland produce calcitonin - it controls the metabolism of Ca. Thyroid hormones can be produced only if the normal level of iodine, it is their basis. Thyroid hormones control and regulate the work of all body systems. The gland is responsible for the metabolic rate, heart rate, heart rate, blood pressure, mood, intellect and other teeth, muscle tone.
They can manifest in the direction of hyper- or hypofunction. Especially these disorders are fraught for children and adolescents, because they cause severe pathologies in the future.
The work of the thyroid gland may depend on environmental degradation, stress, poor nutrition, abnormalities of the internal organs, pituitary, iodine deficiency. Each side of the violations has its own clinic.
Hyperthyroidism or increased function
Thyroxine is produced more than the norm. Each system in the body works with increasing speed, so the following symptoms appear:
- hell rises
- quickens the pulse
- nausea, diarrhea, increased appetite,
- weight decreases,
- there is a sensitivity to heat
- возникает тремор тела и рук бессонница, неустойчивость настроения с гневливостью,
- развивается экзофтальм (пучеглазие),
- мужская потенция и МЦ у женщин нарушаются.
Hyperthyroidism is noted in thyroid cancer. In diseases of the thyroid gland with its increased function is often appointed RIT.
Hypothyroidism or decreased function
Here is the opposite picture - the work of each organ slows down. In children, it leads to insanity and growth retardation, blood pressure decreases, bradycardia appears, emotions are often suppressed, a person becomes slow, hormonal disruptions and infertility appear in women, impotence in men, chilliness, pastyness of legs, hands, face, tongue swelling, hair fall out and slowly grow, the slow growth of nails, the skin becomes dry, weight increases, and fat is deposited around the abdomen and thighs, appetite decreases and constipation appears.
Hypofunction is noted in every tenth woman. The development of violations occurs gradually, the woman often does not notice. In women of fertile age, thyroid hypofunction increases prolactin and stably estrogen production.
The thyroid is hypertrophied and goiter appears - a manifestation of hypofunction (endemic goiter). In the form of a tumor on the front of the neck, it squeezes the trachea, the voice becomes hoarse, a lump in the throat and a lack of air.
Treatment of hyperthyroidism
Therapy is carried out with suppression of excess production of thyroxine. At the same time, various negative effects are often observed after treatment, which is why today many doctors advocate the use of RET - radioiodine -131. It often replaces thyroidectomy.
Treatment of the thyroid gland with radioactive iodine began in 1934 in the United States. And only after 7 years, the method began to be applied in other countries.
In America and Israel, such patients are served on an outpatient basis (this is cheaper), in Europe and Russia, radioiodine treatment is carried out in a hospital. The method is based on the use of radioactive iodine (radioiodine, I-131) - this is one of the 37 isotope existing in iodine-126, which is always present in everyone in the first-aid kit.
Radioiodine is able to completely destroy the affected tissue (follicular cells) of the thyroid gland. Its half-life in the human body is 8 days, during which 2 types of radiation appear in the body: beta and gamma radiation. They both have a high penetrating power in the tissue, but beta-radiation has a healing effect. It immediately goes to the glandular tissues around the clusters of radioiodine.
The depth of penetration of these rays is small - only 0.5-2 mm. Moreover, this range works only within the gland itself.
Gamma particles have not less penetrating ability and they pass into any human tissue. They have no curative effect, but they help to detect the localization of radioiodine clusters in the form of luminous foci with special gamma cameras.
This is important in diagnosing the detection of thyroid cancer metastases, usually after RIT. The therapeutic effect occurs 2-3 months after treatment, as well as during surgical treatment.
If a relapse occurs, treatment may be repeated. Therapy with such iodine is carried out only by a highly qualified specialist to eliminate side effects.
ITT often becomes the only chance to save a patient with a diagnosis of differentiated thyroid cancer. Referral to such treatment is not given to each patient due to contraindications.
Indications for use of radioactive iodine
Indications for treatment with iodine can be:
- Hyperthyroidism with the appearance of benign nodules,
- Thyrotoxicosis is an extreme degree of thyrotoxicosis with an excess of hormones,
- Nodular and diffuse toxic goiter (Grave disease) - these 2 pathologies use RET instead of surgery,
- All types of thyroid cancer with the addition of inflammation in the glandular tissue, first of all, thyroid carcinomas - a tumor from papillary, medullary and follicular gland cells.
- Metastases of cancer of the thyroid gland, RJT are performed after thyroidectomy.
Treatment of thyroid carcinomas with radioactive iodine makes it possible to fully cure.
- lactation period
- general serious condition
- severe hepatic and mon,
- gastric and duodenal ulcer,
- Diabetes in severe form
- active TB.
The method is well studied, safe and specific precautions have been developed for it. The age of restrictions does not give, RJT was carried out and children 5 years.
There is no need for anesthesia, there is no rehabilitation period, radiation does not spread to other organs, there is no mortality, no scars or scars appear. Sore throat after taking the capsule is easily stopped by local exposure.
To plan a pregnancy, it should take at least six months after treatment. Better yet, planning healthy offspring should be carried out 2 years after treatment, the development of hypothyroidism. Complications can be in the form of edematous exophthalmos (autoimmune ophthalmopathy). An accumulation of a small part of radioiodine in the mammary glands, ovaries and prostate is possible, narrowing of the lacrimal and salivary glands, weight gain, the appearance of fibromyalgia and feelings of fatigue are possible. Possible exacerbation of chronic diseases of the gastrointestinal tract, kidneys, nausea, taste disorders.
All these disadvantages are easily treated and short-lived. Discomfort passes quickly. The risk of cancer of the small intestine increases, RITT opponents like to point out the loss of the thyroid forever, but does the surgical removal of the thyroid recover?
RYT preparatory period
It lasts an average month or more. In preparation, it is necessary to increase the number of TSHs that control the work of the thyroid gland. The higher it is, the greater will be the effect of radiotherapy, because cancer cells quickly destroy it.
The increase in TSH can be done in 2 ways: the introduction of recombinant TSH (artificial) or the abolition of thyroxine a month before the capsule.
This is necessary so that the cells of the thyroid gland become more active in absorbing radioiodine. Cancer cells no matter what iodine they absorb. The more they devour it, the faster they die.
Diet in preparation
Nutrition in the preparation should also be free from - for 3-4 weeks. It is tolerated easily. In practice, this is a vegetarian diet. This requires the exclusion of algae and seafood, dairy, egg yolks, red beans, soy products, rolled oats, grapes, persimmon and apples, semi-finished products from the diet.
In the food should not be a food additive E127 - red food coloring - it is added to canned meat, salami, canned fruit with cherries and strawberries, candy and pink marshmallow. Salt to use normal, without iodine. The diet not only relieves the body, but also restores the body more quickly after taking the capsule.
The process of radioiodine therapy
When treating, most often taking a capsule is a one-time, rarely in the form of a course. Selects the capsule in the right dose after the diagnosis of the attending physician. It is prepared individually. After swallowing the capsule, it is advisable to have a 5-day observation by a doctor. Need strict isolation. On the day when the capsule is taken, food is not taken 2 hours before and after administration.
Fluid intake should be increased. It helps to remove the isotope from the body. Isolation of the patient without a visit with the adoption of the capsule is necessary, since the body, although weak, releases radioactive radiation. All things and accessories of the patient are optimally eliminated with the observance of radiation protection measures. Bed linen should be changed daily, the toilet is also processed after each visit.
Tips for isolation:
- wash and change clothes daily
- drink sour drinks and chew gum to increase saliva production,
- every 2-3 hours to go to the toilet,
- use disposable dishes
- any devices near the patient, cover with polyethylene or use rubber gloves,
- distance from the patient at least 3 m.
3 days after treatment with radioactive iodine of the thyroid gland (taking the capsule) at the reception at the endocrinologist, the degree of iodine release from the body is checked by scanning in a gamma camera. If it is still a lot - insulation is extended. In a month hormonal treatment is prescribed.
Treatment with radioactive iodine (radioiodine therapy) of the thyroid gland and the consequences are not comparable in degree. The efficiency of the RJT method is high - 98%, no lethal cases have been registered. Side effects and effects of radioactive iodine treatment are short-lived, but you should be aware of them.
This tingling in the tongue, tickling in the pharynx, dry mouth, nausea, swelling in the form of a slight swelling on the neck, a change in taste sensations. The panicked fear of patients before, allegedly, with radiation on the whole body during REIT is baseless.
Radioactive iodine - non-surgical treatment of the thyroid - an alternative to surgical intervention. There are no methods equal to this method. Moreover, chemotherapy for thyroid cancer does not help.
RIT is an effective and easy way to treat thyroid cancer. Proper performance of RET in a patient who has passed capsule intake and isolation does not give any side effects. World experience in the use of RJT does not give side effects on pregnancy and the birth of healthy offspring. Greater harm can be caused to pregnancy and the child with thyrotoxicosis with thyrostatic medication.
Etiology and pathogenesis of nodular toxic goiter
The thyroid gland is an endocrine gland that produces iodine-containing hormones, which are actively involved in metabolic processes, are involved in the growth and regeneration of tissues, as well as the maturation of organs. Various diseases of the thyroid gland arise as a result of increased or decreased endocrine function. Nodular toxic goiter of the thyroid gland is a disease that is characterized by hyperfunction of benign tumors and excessive production of thyroid hormones.
Nodular goiter is a collective clinical concept that refers to all tumors of the thyroid gland, which differ in their properties from the rest of the tissue. Nodular goiter is determined in patients during visual examination or during palpation. The goiter is usually visible to the naked eye and you can notice certain changes on your own, but if the nodes have a diameter of less than 1 cm, then they can only be detected by ultrasound. To confirm the diagnosis prescribed laboratory tests that determine the level of hormones in the blood of the patient. If the doctor considers it necessary, then the patient is prescribed a specific biopsy.
Causes of toxic goiter
Why does toxic goiter arise and how to distinguish it from other thyroid diseases?
Nodular goiter occurs as a result of hyperfunction of certain parts of the thyroid gland and its enlargement, which leads to disruption of its work. Such formations can be benign or malignant. If the patient is found to diagnose less than 2 nodes, then such a toxic goiter is usually called nodular, and if more than 2 nodes, then it is multi-node.
One of the criteria for differential diagnosis is that toxic goiter does not cause the patient to have a special form of endocrinological ophthalmopathy — an autoimmune pathology characterized by involvement of the organs of vision (eyes and orbital tissues) in the pathological process.
The patient may experience the following symptoms:
- violations of the general psychosomatic condition: weakness, fatigue and low performance, drowsiness and irritability,
- hair loss and brittle nails,
- various irregularities in the work of the heart: tachycardia, arrhythmia and recurrent pain in the heart,
- difficulty swallowing and breathing, discomfort in the throat:
- hand tremor and skin changes.
Treatment methods and medical prognosis
There are several priority areas in the treatment of thyroid diseases:
- surgery. Complete or partial removal of the gland, depending on the location of the tumor and the number of nodes,
- conservative treatment. Hormone therapy with constant dispensary control,
- destruction of nodes using an electromagnetic field or a laser,
- radioiodine therapy.
Surgical removal of the thyroid gland is considered to be the most effective treatment method. If toxic goiter is benign, the prognosis is favorable. When the process is malignant, everything depends on the stage of the disease and the capabilities of the clinic to which you turned. Do not self-medicate, it may not only not bring the desired result, but also cause serious complications. The key to successful treatment is timely access to a doctor who will prescribe adequate therapy and other preventive measures: diet, healthy lifestyle, etc.
Concept of method
In radioiodine therapy, radioactive iodine is used (in the medical literature it can be referred to as iodine-131, radioiodine, I-131) - one of thirty-seven isotopes to all of us known iodine-126, which is present in virtually every first-aid kit.
Possessing a half-life of eight days, radioiodine spontaneously disintegrates in the patient's body. When this occurs, the formation of xenon and two types of radioactive radiation: beta and gamma radiation.
Not less high penetration ability of gamma particles allows them to easily pass through any tissue of the patient's body. For their registration, high-tech equipment is used - gamma cameras. Not producing any therapeutic effect, gamma radiation helps to detect localization of radioiodine clusters.
Having scanned the patient's body in a gamma camera, a specialist can easily identify the foci of a radioactive isotope.
This information is of great importance for the treatment of patients suffering from thyroid cancer, since the luminous foci that occur in their bodies after a course of radioiodine therapy allow us to conclude that there is a malignant neoplasm and location of the metastases.
The main goal of treatment with radioactive iodine is the complete destruction of the tissues of the affected thyroid gland.
The therapeutic effect, coming two to three months after the start of therapy, is akin to the result obtained by surgical removal of this organ. For some patients with a relapse of the pathology, a second course of radioiodine therapy may be prescribed.
Indications and contraindications
Radio therapy is prescribed for the treatment of patients suffering from:
- Hyperthyroidism is a disease caused by increased activity of the thyroid gland, accompanied by the appearance of small benign nodular tumors.
- Thyrotoxicosis is a condition caused by an excess 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 addition of the inflammatory process. Treatment with radioactive iodine is especially necessary for patients in whose body distant metastases have been discovered, which have the ability to selectively accumulate this isotope. The course of radioiodine therapy in relation to such patients is carried out only after the surgery to remove the affected gland. With the timely use of radioiodine therapy, most patients with thyroid cancer can be completely cured.
Radioiodine therapy has proven to be effective in the treatment of goitre, as well as nodular toxic goiter (otherwise called functional autonomy of the thyroid gland). In these cases, radioactive iodine treatment is used instead of surgery.
The use of radioiodine therapy is especially justified in the case of recurrence of the pathology of an already operated thyroid gland. Most often, such relapses occur after surgery to remove diffuse toxic goiter.
Given the high likelihood of postoperative complications, experts prefer to use the tactics of radioiodine treatment.
The absolute contraindication to the appointment of radio therapy is:
- Pregnancy: the effect of radioactive iodine on the fetus can provoke the defects of its further development.
- Breastfeeding period. Nursing mothers taking radioactive iodine treatment need to wean the baby for quite a long time.
Pros and cons of the procedure
The use of iodine-131 (compared with surgical removal of the affected thyroid gland) has a number of advantages:
- It is not associated with the need to introduce the patient in a state of anesthesia.
- Radiotherapy does not require a rehabilitation period.
- After isotope treatment, the patient's body remains unchanged: there are no scars and scars (inevitable after the operation) that disfigures the neck.
- Laryngeal edema and unpleasant sore throat, developing in a patient after taking a capsule with radioactive iodine, can be easily controlled with the help of local preparations.
- Radioactive radiation associated with the reception of an isotope, is localized mainly in the tissues of the thyroid gland - it almost does not apply to other organs.
- Поскольку повторная операция при злокачественной опухоли щитовидной железы может представлять угрозу для жизни больного, радиойодтерапия, способная полностью купировать последствия рецидива, представляет совершенно безопасную альтернативу хирургическому вмешательству.
В то же самое время радиойодтерапия имеет внушительный список негативных моментов:
- Ее нельзя применять по отношению к беременным женщинам. Кормящие матери вынуждены прекращать грудное вскармливание своих детей.
- Given the ability of the ovaries to accumulate a radioactive isotope, it will be necessary to protect themselves from the onset of pregnancy for six months after completion of therapy. Due to the high probability of disorders associated with the normal production of hormones necessary for the proper development of the fetus, it is necessary to plan the appearance of offspring only two years after the use of iodine-131.
- Hypothyroidism, which inevitably develops in patients undergoing radioiodine therapy, will require long-term hormone therapy.
- After the application of radioiodine, there is a high likelihood of the development of autoimmune ophthalmopathy, leading to a change in all the soft tissues of the eye (including nerves, fatty tissue, muscles, synovial membranes, adipose and connective tissues).
- A small amount of radioactive iodine accumulates in the tissues of the mammary glands, ovaries and prostate gland.
- Exposure to iodine-131 can provoke a narrowing of the lacrimal and salivary glands with a subsequent change in their functioning.
- Radioiodine therapy can lead to significant weight gain, the appearance of fibromyalgia (marked muscle pain) and causeless fatigue.
- With the treatment of radioactive iodine exacerbation of chronic diseases can occur: gastritis, cystitis and pyelonephritis, patients often complain of changes in taste, nausea and vomiting. All of these conditions are short-lived and respond well to symptomatic treatment.
- The use of radioactive iodine increases the likelihood of developing a malignant tumor of the small intestine and the thyroid gland.
- One of the main arguments of opponents of radio therapy is the fact that the thyroid gland, destroyed as a result of exposure to the isotope, will be lost forever. As a counterargument, it can be argued that after surgical removal of this organ, its tissues are also not subject to recovery.
- Another negative factor of radioiodine therapy is associated with the need for three-day strict isolation of patients who have taken a capsule with iodine-131. Since their body then begins to release two types (beta and gamma) of radioactive radiation, during this period, patients become dangerous to others.
- All clothes and items used by the patient undergoing radioiodine treatment are either subject to special treatment or disposed of with the observance of radioactive protection measures.
What is better, surgery or radioactive iodine?
Opinions on this score are controversial, even among professionals involved in the treatment of diseases of the thyroid gland.
- Some of them believe that after thyroidectomy (surgery to remove the thyroid gland) a patient taking estrogen-containing drugs can lead a completely normal life, since the regular intake of thyroxin can replenish the function of the missing gland without causing any side effects.
- Proponents of radioiodine therapy put the main emphasis on the fact that this type of treatment completely eliminates the side effects (the need for anesthesia, the removal of the parathyroid glands, damage to the recurrent laryngeal nerve), which are unavoidable when performing surgery. Some of them are even cunning, claiming that radioiodine therapy will lead to euthyroidism (normal functioning of the thyroid gland). This is an extremely erroneous statement. In fact, radioiodine therapy (as well as thyroidectomy surgery) is aimed at achieving hypothyroidism, a condition characterized by the complete suppression of the thyroid gland. In this sense, both methods of treatment have completely identical goals. The main advantages of radioiodine treatment are complete painlessness and non-invasiveness, as well as the absence of the risk of complications arising after surgery. Complications associated with exposure to radioactive iodine, as a rule, are not observed in patients.
So which method is better? In each case, the last word remains for the attending physician. In the absence of contraindications to the appointment of radioiodine therapy in a patient (suffering from, for example, basal disease), he will most likely advise her to prefer it. If the doctor believes that it is more expedient to perform a thyroidectomy operation, it is necessary to listen to his opinion.
It is necessary to start preparing for the isotope reception two weeks before the start of treatment.
- It is desirable to prevent the ingress of iodine on the surface of the skin: Patients are prohibited from smearing wounds with iodine and applying an iodine net on their skin. Patients should refuse to visit the salt room, swim in the sea water and inhale the sea air saturated with iodine. Residents of sea coasts need isolation from the external environment at least four days before the start of therapy.
- Vitamin complexes, food supplements and medications containing iodine and hormones fall under the strict prohibition: their reception should be abandoned four weeks before radioiodine therapy. A week before taking radioactive iodine, all drugs prescribed for the treatment of hyperthyroidism are canceled.
- Women of childbearing age are required to do a pregnancy test: This is necessary to eliminate the risk of pregnancy.
- Before the procedure of taking a capsule with radioactive iodine, a test is performed for the absorption of radioactive iodine by the tissues of the thyroid gland. If the gland was removed operatively, a sensitivity test to iodine of the lungs and lymph nodes is carried out, since it is they who assume the function of iodine accumulation in such patients.
Diet before therapy
The first step in preparing the patient for radioiodine therapy is to follow a low-diet diet aimed at reducing the iodine content of the patient in every possible way so that the effect of the radioactive drug will have a more tangible effect.
The appointment of a diet with a low iodine content requires an individual approach to each patient, therefore, the recommendations of the attending physician in each case are of decisive importance.
Low diet does not mean that the patient should refuse salt. You should only use the non-iodized product and limit its amount to eight grams per day. The diet is called low-water because the use of foods with low (less than 5 μg per serving) iodine content is still allowed.
Patients who are to undergo radio therapy should completely stop using:
- Seafood (shrimp, crab sticks, sea fish, mussels, crabs, seaweed, seaweed and dietary supplements based on them).
- All types of dairy products (sour cream, butter, cheeses, yoghurts, dry milk porridges).
- Ice cream and milk chocolate (a small amount of dark chocolate and cocoa powder are allowed to be included in the patient's diet).
- Salted peanuts, instant coffee, chips, canned meat and fruit, french fries, oriental dishes, ketchup, salami, pizza.
- Dried apricots, bananas, cherries, applesauce.
- Iodized eggs and dishes with lots of egg yolks. This does not apply to the use of egg proteins that do not contain iodine: during the diet you can eat them without any restrictions.
- Dishes and products painted in different shades of brown, red and orange, as well as medicines containing food dyes of similar colors, since many of them can contain iodine-containing dye E127.
- Bakery products factory production, containing iodine, cornflakes.
- Soy products (tofu cheese, sauces, soy milk) rich in iodine.
- Greens of parsley and dill, leaf and watercress.
- Cauliflower, zucchini, persimmon, green pepper, olives, potatoes, baked in the "uniform".
In the period of a low-diet, use is allowed:
- Peanut butter, unsalted peanuts, coconuts.
- Sugar, honey, fruit and berry jams, jellies and syrups.
- Fresh apples, grapefruits and other citrus fruits, pineapples, cantaloupe, raisins, peaches (and juice from them).
- White and brown rice.
- Egg noodles.
- Vegetable oils (with the exception of soy).
- Raw and freshly prepared vegetables (exception is peeled potatoes, beans and soy).
- Frozen vegetables.
- Poultry meat (chicken, turkey).
- Beef, veal, lamb meat.
- Dried herbs, black pepper.
- Cereal dishes, pasta (in limited quantities).
- Carbonated soft drinks (lemonade, dietary cola, not containing erythrosine), tea and well-filtered coffee.
Radioactive iodine treatment of the thyroid gland
This type of treatment is one of the highly effective procedures, a distinctive feature of which is the use of small amounts of radioactive substances that selectively accumulate in precisely those areas that require therapeutic treatment.
Compared with remote radiation exposure (at a comparable exposure dosage), radioiodine therapy has been proven to create a radiation dose in the tissues of the tumor focus that is 50 times higher than the radiation treatment rates, while bone marrow cells and bone and muscle structures are dozens times smaller.
Selective accumulation of a radioactive isotope and shallow penetration of beta particles into the thickness of biological structures provides the possibility of a point effect on the tissues of tumor foci with their subsequent destruction and complete safety with respect to the adjacent organs and tissues.
How is the procedure radioiodine therapy? During the session, the patient receives a gelatin capsule of normal size (devoid of smell and taste), inside which is radioactive iodine. The capsule should be swallowed quickly, washed down with a large (at least 400 ml) amount of water.
Sometimes a patient is offered radioactive iodine in liquid form (usually in a test tube). After taking this drug, the patient will have to thoroughly rinse the mouth, then swallowing the water used for this. Patients using removable dentures will be asked to remove them before the procedure.
In order for the radioiodine to be better absorbed, having provided a high therapeutic effect, the patient must refrain from eating and drinking any beverages for an hour.
After taking the capsule, radioactive iodine begins to accumulate in the tissues of the thyroid gland. If it was removed surgically, the accumulation of the isotope occurs either in the tissues remaining from it, or in partially modified organs.
Removal of radioiodine occurs through fecal masses, urine, the secret of sweat and salivary glands, and patient breathing. That is why the radiation will settle on the objects 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 the hospital linen and clothing issued to them.
After receiving radioiodine, patients who are in an isolated box should strictly follow the following rules:
- When brushing your teeth you should avoid splashing water. Rinse the toothbrush thoroughly with water.
- When you visit the toilet, you must carefully use the toilet, preventing splashing of urine (for this reason, men should urinate only sitting). Rinse urine and feces must be at least two times, waiting for the tank to be filled.
- All cases of inadvertent splashing of liquid or discharge should be reported to the nurse or nurse.
- During vomiting, the patient must use a plastic bag or a toilet bowl (vomit should be flushed out twice), but in no case should it be a sink.
- It is forbidden to use reusable handkerchiefs (must be a stock of paper).
- Used toilet paper is washed away with feces.
- The front door should be kept closed.
- Leftover food is folded in a plastic bag.
- Feed through the window of birds and small animals is strictly prohibited.
- Shower should be daily.
- In the absence of a chair (it should be daily), you must inform the nurse: the attending physician will definitely prescribe a laxative.
Visitors (especially small children and pregnant women) are not allowed to a patient in strict isolation. This is done in order to prevent their radiation contamination by the flow of beta and gamma particles.
Patients who have been treated with radioactive iodine are required to:
- Increase the amount of fluid you drink to speed up the elimination of iodine-131 degradation products from the body.
- Take a shower as often as possible.
- Use personal hygiene items.
- Using the toilet, twice to pull off the water.
- Change underwear and bedding daily. Since the radiation is perfectly removed with the help of washing, you can wash the things of the patient along with the clothes of the other family members.
- Avoid close contact with young children: take them in your arms and kiss. Being close to the kids should be as little as possible.
- Within three days after discharge (it is carried out on the fifth day after the isotope is taken), sleep only alone, apart from healthy people. Entering into sexual contact, as well as being near a pregnant woman, is allowed only one week after discharge from the clinic.
- If a patient who has recently undergone radioactive iodine treatment is urgently hospitalized, he is obliged to report this to the medical staff, even if exposure was carried out in the same clinic.
- All patients who have undergone radioiodine therapy will take thyroxin for life and visit the endocrinologist's office twice a year. Otherwise, the quality of their life will be the same as before the treatment. The above limitations are of short duration.
Radio therapy can cause certain complications:
- Sialadenitis - an inflammatory disease of the salivary glandscharacterized by an increase in their volume, compaction and soreness. The impetus for the development of the disease is the introduction of a radioactive isotope against the background of the absence of a remote thyroid gland. In a healthy person, thyroid cells would activate, seeking to eliminate the threat and absorb radiation. In the body of the operated person, the salivary glands assume this function. Progression of sialadenitis occurs only when a high dose (above 80 millicurie - mCi) is received.
- Various reproductive disorders, but such a reaction occurs only as a result of repeated exposures with a total dosage exceeding 500 mCi.
Several years ago, I suffered a lot of stress, after which I was given a terrible diagnosis - toxic diffuse goiter, or Graves' disease. The heartbeat was such that I could not sleep. Because of the constantly experienced heat, I walked around all winter long in a T-shirt and light jacket. My hands were shaking, tormented by severe shortness of breath. Despite my good appetite, I became very thin and felt tired all the time. And to top it all - a goiter appeared on the neck. Huge and ugly. I tried a lot of drugs, went through acupuncture and oriental massage sessions. Appealed even to psychics. There was no sense. In complete despair, I decided on radioiodine therapy. The treatment took place in the Warsaw clinic. The whole procedure took two days. On the first day, I passed the analyzes and the isotope capture test. The next morning, a scintigraphy procedure was performed. Summing up the results of the research, the doctor assigned me a dose of radioiodine equal to 25 mCi. The radiotherapy session went very quickly: a capsule was removed from a container with a radioactivity icon using a plastic tube. I was asked to take a sip of water from a disposable cup and stick my tongue out. After the capsule was in my tongue (I did not touch anything with my hands), they gave me water again. Shaking my hand and wishing me health, the doctor released me from the office. The procedure has been completed. I did not experience any special sensations. The next morning, a little sore throat. After a couple of hours it passed. The next day, a little decreased appetite. Ten days later I felt the first signs of improvement in health. Pulse slowed down, forces began to arrive, the goiter began to decrease just before my eyes. Eight weeks after radio therapy, the neck became thin and beautiful again. Normalization of tests occurred after six weeks. From the side of the thyroid gland now there are no problems, I feel like a completely healthy person.
- Citizens of the Russian Federation who have a policy of compulsory medical insurance and who need radioactive iodine treatment are eligible for a free quota. First, you need to contact (using an e-mail or by phone) with one of the medical institutions that have a radiology department and find out if they can accept a specific patient for treatment.
After reviewing the package of medical documents (it takes them two or three days to consider them), the leading specialists of the medical institution decide whether to issue a quota. As practice shows, the chances of getting a quota by the end of the year are extremely small, so you should not plan treatment for this period.
Получив отказ в одной клинике, не стоит отчаиваться. Следует обзвонить все медицинские учреждения, в которых осуществляют радиойодтерапию. Проявив определенную настойчивость, можно добиться получения квоты.
- Совсем другая ситуация наблюдается в случае, если больной в состоянии оплатить свое лечение. Unlike patients who are forced to stand in line for a free quota and not having the right to choose a medical institution, a person who has paid for a course of radioiodine therapy can attend it at any clinic he or she likes.
The cost of radioiodine therapy is determined on the basis of 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 at the Obninsk Radiological Center is as follows:
- A patient receiving a radioiodine in a dosage equal to 2 GBq (gigabekkerely) and placed in a single room, will pay for the treatment of 83,000 rubles. Accommodation in a double chamber will cost him 73,000 rubles.
- If the dosage of the radioiodine was equal to 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 the prices quoted are approximate. Specify information about the cost of treatment is necessary in a conversation with the responsible staff of the medical institution.
Where are they treated with radioiodine therapy in Russia?
You can complete a course of radioactive treatment of the thyroid gland in a number of Russian clinics:
- in the Moscow Federal State Budgetary Institution "Russian Research Center for X-ray Radiology",
- in the Arkhangelsk "Northern Medical Clinical Center named after N.A. Semashko ",
- in Kazan "Center for Nuclear Medicine",
- in Obninsk "Medical Radiological Scientific Center. A.F. Tsyba ",
- in the radiology department of the City Clinical Hospital No. 13, located in Nizhny Novgorod,
- in the radiology department of the Omsk Regional Clinical Hospital,
- at the Krasnoyarsk Center for Nuclear Medicine of the Siberian Clinical Center of the Federal Medical and Biological Agency of Russia.
Thyroid Cancer Treatment
Why only a limited number of clinics treats the thyroid gland with radioactive iodine (131I) in Moscow and other cities? The fact is that painless, safe for the patient and having a fairly high efficiency in a number of diseases, the treatment method involves the use of open sources of ionizing radiation, which requires the medical institution to take strict radiation safety measures. In particular, special rooms are provided for patients with special sewage, ventilation and air circulation systems, and all radioactive waste is disposed of in accordance with radiation safety standards. The activities of clinics where radionuclide therapy is carried out are strictly licensed. That is why there are very few medical centers where they can provide appropriate treatment - they are represented in Moscow, Obninsk and several other cities.
In our center we receive patients according to the VMP FREE PROGRAM (HIGH-TECH MEDICAL AID) and also according to the LCA program (VOLUNTARY MEDICAL INSURANCE), thanks to which this therapy is made available to the widest range of people.
Mainly, the cost of radioiodine therapy is determined by the price of the drug and the length of stay in the hospital. At the same time, it is difficult to say in advance exactly how many days the patient will have to spend in a special ward, since the body cleansing the body from the radioisotope at all takes place at different speeds. In any case, our doctors will calculate the exact activity of 131I, which, on the one hand, will be most effective, and on the other, will allow us to return to normal life as soon as possible.
Features of radioiodine therapy for the treatment of diseases of the thyroid gland
Radioiodine therapy shows the greatest efficacy in diseases such as diffuse toxic goiter (Graves disease), toxic thyroid adenoma. In most cases, patients with a diagnosis of thyroid cancer iodine treatment is indicated.
The method is based on the fact that thyrocytes (normal thyroid cells, as well as highly differentiated thyroid cancer cells) accumulate iodine, while iodine-131 destroys them.
Therapy takes place with a minimal number of side effects, such treatment is becoming more widely used throughout the world.
Stay in the ward during radioactive iodine treatment
The peculiarities of staying in the hospital during radioiodine therapy are explained by the fact that after taking the drug for a short time, patients become a source of gamma radiation. That is why they should stay in special chambers that have separate ventilation and sewage systems, as well as a special air circulation system.
For obvious reasons, visits of relatives to such chambers are not provided for, and the list of things that you can take with you is rather limited and is discussed with the specialists of the clinic. Remember that most of the things will be recycled, with the exception of material (equipment) or medical (for example, crutches) value. However, they will be returned to you only after their radiation background returns to normal.
Despite the strict rules regarding security, otherwise we tried to make the stay in the ward as comfortable as possible. Our specialists have 7 rooms (12 beds) for those who receive radioiodine therapy. Each has a TV, fridge, kettle, internet access, shower, bathroom. Furnishings, quality repairs and tasty food also produce an exceptionally favorable impression.