RADIOACTIVE IODINE
for Remnant Ablation and Metastatic Thyroid Carcinoma
Your provider has ordered radioactive iodine for the purpose of thyroid ablation for treatment of hyperthyroidism or nodules. The purpose of this packet is to explain the risks and benefits of radioactive iodine, the preparation for the treatment, and the precautions to follow after the administration. Included in this packet are consent forms for treatment, a list of precautions including time periods to be followed, and a list of frequently asked questions. Please read this packet carefully and make sure that you understand its contents. If you have further questions, please write them down as they can be discussed over the phone or at a nursing visit if necessary.
The Diabetes and Thyroid Center of Fort Worth is one of the few endocrinology clinics in Texas that administers radioactive iodine (I-131) in the clinic for treatment of various thyroid disorders. The licensure of the provider requires extensive classroom and laboratory training and compliance with strict regulations mandated by the State of Texas and the United States Nuclear Regulatory commission.
Thyroid tissue typically will take up (absorb) iodine. Thyroid antibodies and/or overactive thyroid nodules tend to cause a greater than normal uptake. By prescribing you this dose of iodine, the objective is to either attempt to ablate the entire gland if you have Graves Disease or to ablate the nodule(s) if you have overactive nodules.
After this ablation it is necessary for you to follow up regularly as prescribed by your provider in order to follow lab work and your symptoms. It may be necessary for you to start thyroid hormone replacement within a six month period. Once started, typically you will be taking this therapy for the rest of your life.
This entire process, although new to you, is common in our practice. Rest assured that our medical assistants, administrative staff, and providers are here to make your treatment go as smoothly as possible.
Sincerely,
Darren Lackan, MD, FACE
Anjanette Tan, MD, FACE
You will not significantly contaminate a room, our computer, phone, remote controls, or other personal items by having limited general contact with these items. The main source of radiation to others is from radiation given off as the medication changes to a non-radioactive form. This radiation that is given off is similar to x-rays. The radioactive iodine also concentrates in your bodily fluids including but not limited to perspiration, saliva, urine, feces, vaginal secretions, and semen. Significant contamination will occur if you urinate, perspire, or salivate on one of these items. It is important to follow the list of precautions to limit other people’s exposure to these bodily fluids and released radiation.
No, it is not necessary to throw away clothes and bedding. We recommend that you wash your clothing and bedding separately from others for two weeks. We do recommend that you throw away your toothbrush after two weeks.
We recommend that you do not prepare food for others for at least 1 week.
It is not necessary to use disposable dishes. You can use your regular dishes as long as you wash them separately from others for at least 1 week.
The amount of radioactive iodine that you will be receiving could result in severe damage or death to an unborn child if you are pregnant. We require that all women under the age of 50 that have not undergone tubal ligation or hysterectomy have a negative serum pregnancy test prior to dosing the radioactive iodine. The radioactive iodine will not be administered without this test being performed.
Children are more susceptible to radiation as their tissues are dividing at a higher rate than adults. Because of this, they have a greater risk of developing cancer if significantly exposed. We ask that you stay at least 6 feet away from children for 10 days. Drs. Lackan and Tan all have young children and understand how difficult this precaution is to follow, but our providers also understand the potential risk to the children and the need to absolutely follow this precaution.
It is important to limit exposure to adults as there is risk of damaging their tissue with significant exposure. We ask that you sleep in a separate bed and refrain from kissing or sexual intercourse for 7 days.
This depends on what type of work you do and your ability to isolate yourself from others. If you are able to stay 6 feet from other adults and children, you can return to work within a few days. If you are near other adults that are not potentially pregnant women, you can return to work after 5-7 days, but if you work with or near children or potentially pregnant women, you need to stay off of work for 10-14 days.
Basically, we want to flush the excess radioactive iodine out of your body as fast as possible. Since the iodine will clear through the salivary glands, feces, and urine, it is important to expedite this by drinking plenty of fluids and use laxatives if necessary to maintain at least 1-2 bowel movements a day. The lemon wedges or sour candy should be used 24 hours after taking the radioactive iodine as it stimulates saliva production and clearance through the saliva glands.
Almost all patients tolerate the dose of radioactive iodine without significant nausea and/or vomiting. If requested, your provider can prescribe nausea medication. If you do happen to vomit in a public place prior to isolating yourself at home, you should notify our office immediately as we will need to notify the proper Texas officials and HazMat. If you need to vomit at home, please do so in the toilet. Please let your provider know at what time this occurred to make sure that an adequate dose remains.
If you have an emergency, please proceed to the ER as you usually would. We ask that you inform the triage nurse or ER staff that you recently received radioactive iodine and need to be seated separately from the general public. Please bring a copy of this paperwork with you and ask the physician to call the clinic with any questions.
Once you have received the radioactive iodine, it is necessary for you to follow the precautions. Our clinic is a public place where you can be in extended contact with children and potentially pregnant females including our staff and patients. If you feel it is necessary to see one of our providers before your scheduled appointment, it is required that you call and speak with one of the medical assistants. If the provider feels it is necessary to see you, he or she will bring you through the back door and into a separate room to evaluate you. DO NOT walk into the clinic without setting up an appointment first as you will be asked to leave immediately.
Radioactive iodine is concentrated in your sweat, therefore it is recommended that you not perform vigorous exercise for at least 7 days. Your provider may give you further instructions regarding refraining from exercise while hyperthyroid. Please discuss this with your provider prior to the treatment if you have further concerns
If you are breastfeeding prior to the administration of radioactive iodine, it is vital that you stop immediately after dosage is administered and you will not be able to resume breastfeeding for this child. Radioactive iodine is mildly concentrated in the breast and can cause potentially severe damage in the infant if breastfeeding is continued after radioactive iodine dosing. Radioactive iodine should not prevent breastfeeding future children.
We ask that you not get pregnant until 6-12 months after treatment with last dose of radioactive iodine. We recommend that you use birth control for at least 6-12 months after receiving dose.