Therapy with radioactive iodine. Instructions for Radioactive Iodine: indications, contraindications and diet. Efficacy and safety of radioactive iodine treatment

Treatment with radioactive iodine is sometimes the only chance to save a person suffering from one of the forms (papillary or follicular) differentiated cancer thyroid gland.

The main goal of radioiodine therapy is the destruction of thyroid follicular cells. However, not every patient can get a referral for this type of treatment, which has a number of indications and contraindications.

What is radioiodine therapy, in what cases is it used, how to prepare for it, and in which clinics can one receive treatment? All these questions can be answered in our article.

In radioiodine therapy, radioactive iodine is used (in the medical literature it can be referred to as iodine-131, radioiodine, I-131) - one of the thirty-seven isotopes we all know of iodine-126, which is available in almost every first-aid kit.

With a half-life of eight days, radioiodine breaks down spontaneously in the patient's body. In this case, the formation of xenon and two types of radioactive radiation: beta and gamma radiation.

The therapeutic effect of radioiodine therapy is provided by the flow of beta particles (fast electrons), which have an increased penetrating ability into biological tissues located around the iodine-131 accumulation zone due to the high escape velocity. The penetration depth of beta particles is 0.5-2 mm. Since their range is limited to these values ​​only, radioactive iodine works exclusively within the thyroid gland.

The equally high penetrating power 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 the localization of radioiodine accumulations.

Having scanned the patient's body in a gamma camera, the specialist can easily identify the foci of accumulation of a radioactive isotope.

This information has great importance for the treatment of patients suffering from thyroid cancer, since the luminous foci that appear in their bodies after a course of radioiodine therapy make it possible to draw a conclusion about the presence and location of metastases of a malignant neoplasm.

The main goal of radioactive iodine treatment is the complete destruction of the tissues of the affected thyroid gland.

The therapeutic effect, which occurs two to three months after the start of therapy, is akin to the result obtained during the surgical removal of this organ. Some patients with a recurrence of pathology may be assigned a second course of radioiodine therapy.

Radioiodine therapy is prescribed for the treatment of patients suffering from:

• Hyperthyroidism is a disease caused by an increased activity of the functioning of the thyroid gland, accompanied by the appearance of small benign nodular neoplasms.
• Thyrotoxicosis - a condition caused by an excess of thyroid hormones, which is a complication of the aforementioned disease.
• All types of thyroid cancer characterized by the occurrence malignant neoplasms in the tissues of the affected organ and accompanied by the addition inflammatory process. Treatment with radioactive iodine is especially necessary for patients whose bodies have been found distant metastases, which have the ability to selectively accumulate this isotope. The course of radioiodine therapy in relation 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 suffering from thyroid cancer can be completely cured.

Radioiodine therapy has proven effective in the treatment of Graves' disease, as well as nodular toxic goiter (otherwise referred to as 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 case of recurrence of the pathology of the already operated thyroid gland. Most often, such relapses occur after operations to remove diffuse toxic goiter.

Given the high likelihood of developing postoperative complications, experts prefer to use radioiodine treatment tactics.

An absolute contraindication to the appointment of radioid therapy is:

• Pregnancy: exposure to radioactive iodine on the fetus can provoke malformations of its further development.
• Infant breastfeeding period. Breastfeeding mothers taking radioactive iodine treatment need to wean the baby for quite a long time.

The use of iodine-131 (compared to surgical removal of the affected thyroid gland) has a number of advantages:

• It is not associated with the need to introduce the patient into a state of anesthesia.
• Radiotherapy does not require a rehabilitation period.
• After treatment with an isotope, the patient's body remains unchanged: no scars and scars (inevitable after surgery) that disfigure the neck remain on it.
• laryngeal edema and unpleasant perspiration in the throat, which develop in a patient after taking a capsule with radioactive iodine, are easily stopped with the help of topical preparations.
• Radioactive radiation associated with the intake of the isotope is localized mainly in the tissues of the thyroid gland - it almost does not spread to other organs.
• Because the reoperation when a malignant tumor of the thyroid gland can pose a threat to the life of the patient, radioiodine therapy, which can completely stop the consequences of a relapse, is a completely safe alternative to surgical intervention.

At the same time, radioiodine therapy has an impressive list of negative aspects:

• It should not be used on pregnant women. Nursing mothers are forced to stop breastfeeding their children.
• Given the ability of the ovaries to accumulate a radioactive isotope, it will be necessary to protect against pregnancy for six months after completion of therapy. Due to the high probability of violations associated with the normal production of hormones necessary for the proper development of the fetus, offspring should be planned only two years after the use of iodine-131.
• Hypothyroidism, which inevitably develops in patients undergoing radioiodine therapy, will require long-term treatment hormonal drugs.
• After the use of radioiodine, there is a high probability of developing autoimmune ophthalmopathy, leading to a change in all soft tissues of the eye (including nerves, fatty tissue, muscles, synovial membranes, fatty and connective tissues).
• A small amount of radioactive iodine accumulates in the tissues of the mammary glands, ovaries and prostate.
• Exposure to iodine-131 can cause constriction of the lacrimal and salivary glands with a subsequent change in their functioning.
• Radioiodine therapy can lead to significant weight gain, fibromyalgia (severe muscle pain) and causeless fatigue.
• Against the background of radioactive iodine treatment, an 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 small intestine and thyroid gland.
• One of the main arguments of opponents of radioidtherapy is the fact that the thyroid gland, destroyed as a result of exposure to the isotope, will be lost forever. As a counterargument, one can argue that after the surgical removal of this organ, its tissues cannot be restored either.
• Another negative factor radioiodine therapy is associated with the need for a three-day strict isolation of patients who have taken a capsule with iodine-131. Since their body then begins to emit two types (beta and gamma) of radioactive radiation, during this period, patients become dangerous to others.
• All clothing and items used by a patient undergoing radioiodine treatment are subject to either special treatment or disposal in compliance with radioactive protection measures.

Opinions on this subject 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 drugs can lead a completely normal life, since a regular intake of thyroxine can replenish the function of the missing gland without causing side effects.
• Supporters of radioiodine therapy make the main emphasis on the fact that this type of treatment completely eliminates side effects (the need for anesthesia, removal parathyroid glands, damage to the recurrent laryngeal nerve), inevitable when performing a surgical operation. Some of them are even cunning, claiming that radioiodine therapy will lead to euthyroidism ( normal operation thyroid gland). This is an extremely erroneous assertion. In fact, radioiodine therapy (as well as thyroidectomy surgery) 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 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, in patients, as a rule, are not observed.

So what is the best technique? In each particular 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 will most likely advise to prefer it. If the doctor believes that it is more expedient to perform a thyroidectomy, you must listen to his opinion.

It is necessary to start preparation for taking the isotope two weeks before the start of treatment.

• It is advisable not to allow iodine to enter the surface skin: patients are forbidden to lubricate wounds with iodine and apply to the skin iodine grid. Patients should refuse to visit the salt room, bathing in sea ​​water and inhalation sea ​​air saturated with iodine. Residents of the sea coasts need isolation from the external environment at least four days before the start of therapy.
• Under strict ban vitamin complexes, nutritional supplements and drugs containing iodine and hormones fall: they should be discontinued 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 take a pregnancy test: this is necessary to eliminate 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 surgically, an iodine sensitivity test of the lungs and lymph nodes is performed, since it is they who take on the function of accumulating iodine in such patients.

The first step in preparing a patient for radioiodine therapy is to follow a low-iodine diet aimed at reducing the iodine content in the patient's body in every possible way so that the effect of the radioactive drug will be more tangible.

Because the low-iodine diet is given two weeks prior to taking the radioactive iodine capsule, the patient is brought to a state of iodine starvation; as a result, tissues capable of absorbing iodine do so with maximum activity.

Prescribing a diet with low content iodine requires an individual approach to each patient, so the recommendations of the attending physician in each case are of decisive importance.

A low-iodine diet does not mean that the patient should give up salt. You should only use a non-iodized product and limit its amount to eight grams per day. The diet is called low iodine because foods low in iodine (less than 5 micrograms per serving) are still allowed.

Patients undergoing radioiodine therapy should completely abstain from:

• Seafood (shrimp, crab sticks, sea ​​fish, mussels, crabs, algae, 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 is allowed to be included in the patient's diet).
• Salted nuts, instant coffee, chips, canned meat and fruit, french fries, oriental dishes, ketchup, salami, pizza.
• Dried apricots, bananas, cherries, applesauce.
• Iodized eggs and dishes with large quantity egg yolks. This does not apply to the use egg whites, not containing iodine: during the diet, you can eat them without any restrictions.
• Dishes and products colored in different shades of brown, red and orange, as well as medicines containing food dyes of similar colors, since iodine-containing dye E127 can be included in many of them.
• Bakery products of factory production containing iodine; corn flakes.
• Soy products (tofu cheese, sauces, soy milk) rich in iodine.
• Greens of parsley and dill, leaf and watercress.
• Cauliflower, zucchini, persimmons, green peppers, olives, potatoes, baked in a "uniform".

During the period of a low-one diet, the use of:

• 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 their juices).
• White and brown rice.
• Egg noodles.
• Vegetable oils (except soy).
• Raw and freshly cooked vegetables (except for potatoes, beans, and soybeans).
• Frozen vegetables.
• Poultry meat (chicken, turkey).
• Beef, veal, lamb meat.
• Dried herbs, black pepper.
• cereal dishes, pasta(in limited quantity).
• Carbonated soft drinks (lemonade, erythrosin-free diet cola), tea, and well-filtered coffee.

This type of treatment is one of the highly effective procedures, distinctive feature which is the use of a small amount of a radioactive substance that selectively accumulates precisely in those areas that require therapeutic exposure.

It has been proven that, compared with external radiation exposure (at a comparable dosage of exposure), radioiodine therapy is able to create a dose of radiation in the tissues of the tumor focus that is fifty times higher than that of radiation treatment, while the effect on cells bone marrow and the structure of bones and muscles turned out to be ten times smaller.

The selective accumulation of the radioactive isotope and the 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 in relation to adjacent organs and tissues.

How is radioiodine therapy performed? During the session, the patient receives a gelatin capsule of the usual size (devoid of smell and taste), inside which is radioactive iodine. The capsule should be swallowed quickly with a large (at least 400 ml) amount of water.

Sometimes the patient is offered radioactive iodine at liquid form(usually in vitro). After taking such a drug, the patient will have to rinse his mouth thoroughly, then swallowing the water used for this. Patients with removable dentures will be asked to remove them before the procedure.

In order for radioiodine to be better absorbed, providing a high therapeutic effect, the patient should refrain from eating and drinking any drinks for an hour.

After taking the capsule, radioactive iodine begins to accumulate in the tissues of the thyroid gland. If she was removed surgically, the accumulation of the isotope occurs either in the tissues remaining from it, or in partially altered organs.

Radioiodine is excreted through stool, urine, secretion of sweat and salivary glands, patient's breath. 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 required to change into the hospital linen and clothes issued to them.

After receiving radioiodine, patients in an isolated box must strictly observe the following rules:

• When brushing your teeth, avoid splashing water. The toothbrush should be thoroughly rinsed with water.
• When visiting the toilet, use the toilet carefully, avoiding splashing of urine (for this reason, men should only urinate while sitting). It is necessary to flush urine and stool at least twice, waiting for the tank to fill.
• Any accidental spillage of fluid or secretions should be reported to the nurse or nurse.
• During vomiting, the patient should use a plastic bag or toilet bowl (flush the vomit twice), but in no case - not a sink.
• It is forbidden to use reusable handkerchiefs (there must be a supply of paper ones).
• Used toilet paper washed away with stool.
• The front door must be kept closed.
• Leftover food is placed in a plastic bag.
• Feeding birds and small animals through the window is strictly prohibited.
• Showering should be daily.
• In the absence of a chair (it should be daily), you need to inform the nurse: the attending physician will definitely prescribe a laxative.

Visitors (especially small children and pregnant women) are not allowed near a patient in strict isolation. This is done in order to prevent their radiation contamination by the flow of beta and gamma particles.

Radioiodine therapy is often given to cancer patients who have undergone thyroidectomy. The main goal of such treatment is the complete destruction of abnormal cells that could remain not only in the location of the removed organ, but also in the blood plasma.

The patient who has taken the drug is sent to an isolated ward, equipped with the specifics of treatment. All contacts of the patient with medical personnel dressed in a special protective suit are limited to the most necessary procedures.

Patients treated with radioactive iodine must:

• Increase the amount of fluid you drink to speed up the elimination of iodine-131 decay products from the body.
• Shower as often as possible.
• Use personal hygiene items.
• Using the toilet, pull off the water twice.
• Change underwear and bedding daily. Since radiation is perfectly removed by washing, you can wash the patient's things together with the clothes of the rest of the family.
• Avoid close contact with small children: pick them up and kiss them. Stay close to babies as little as possible.
• Within three days after discharge (it is carried out on the fifth day after taking the isotope), sleep only alone, separately from healthy people. It is allowed to have sexual intercourse, as well as to be near a pregnant woman, only one week after discharge from the clinic.
• If the patient has recently treated radioactive iodine, urgently ended up in a hospital, he is obliged to inform the medical staff about this, even if the irradiation 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. In all other respects, their quality of life will be the same as before treatment. The above restrictions are temporary.

Radioiodine therapy can cause certain complications:

• Sialadenita - inflammatory disease salivary glands, characterized 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. At healthy person thyroid cells would fire up to eliminate the threat and absorb the radiation. In the body of the operated person, this function is taken over by salivary glands. The progression of sialadenitis occurs only when a high (above 80 millicurie - mCi) radiation dose is received.
• Various violations reproductive function , but such a reaction of the body occurs only as a result of repeated exposures with a total dosage exceeding 500 mCi.

Alyona:

A few years ago, I suffered a lot of stress, after which I was exposed to terrible diagnosis- toxic diffuse goiter, or Graves' disease. The palpitation was such that I could not sleep. Because of the constant heat, I walked around in a T-shirt and a light jacket all winter long. Hands were shaking, tormented severe shortness of breath. In spite of a good appetite I lost a lot of weight and felt tired all the time. And - to top it all off - a goiter appeared on the neck. Huge and ugly. I tried a lot of drugs, went through sessions of acupuncture and oriental massage. She even turned to psychics. There was no point. In complete desperation, I decided on radioiodine therapy. The treatment took place in a Warsaw clinic. The whole procedure took two days. On the first day I passed the tests and the isotope capture test. The next morning, a scintigraphy procedure was performed. Summing up the results of the studies, the doctor prescribed me a dose of radioiodine equal to 25 mCi. The radiotherapy session went very quickly: a capsule was removed from the container with the radioactivity symbol 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), they gave me water again. After shaking my hand and wishing me good health, the doctor let me out of the office. The procedure has been completed. I didn't experience any special feelings. The next morning, my throat was a little sore. It passed after a couple of hours. The next day, my appetite decreased slightly. Ten days later I felt the first signs of improvement in well-being. The pulse slowed down, strength began to arrive, the goiter began to decrease just before our eyes. Eight weeks after radioiodine therapy, the neck was again thin and beautiful. Normalization of analyzes occurred after six weeks. There are no problems with the thyroid gland now, I feel like a completely healthy person.

Having familiarized themselves with the package of medical documents (it takes two or three days to consider them), the leading specialists of the medical institution decide on the appropriateness of issuing 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.

Having received a refusal in one clinic, do not despair. All medical institutions that provide radioiodine therapy should be called. With some perseverance, you can achieve a quota.

• A completely different situation is observed if the patient is able to pay for his treatment. Unlike patients who are forced to stand in line for a free quota and do not have the right to choose a medical institution, a person who has paid for a course of radioiodine therapy can undergo 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.

So, for example, the cost of treatment in the Obninsk radiological center is as follows:

• A patient receiving radioiodine at a dosage of 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 would cost 105,000 rubles; in a double room - 95,000 rubles.

The cost of radioiodine therapy in the medical center of Arkhangelsk ranges from 128,000 to 180,000 rubles. Treatment in the radiology department of the Moscow Scientific Center will cost the patient an amount equal to 120,000 rubles.

Of course, all prices quoted are approximate. It is necessary to clarify information about the cost of treatment in a conversation with the responsible employees of the medical institution.

Pass the course radioactive treatment thyroid gland can be used in a number of Russian clinics:

• at the Moscow Federal State budget institution"Russian Scientific Center for Roentgen Radiology";
• in the Arkhangelsk "Northern Medical Clinical Center named after N.A. Semashko";
• in the Kazan "Center nuclear medicine»;
• Obninsk "Medical Radiological scientific center them. A.F. Tsyba";
• in the radiology 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".

Radioactive iodine is used in endocrinology to treat the thyroid gland. It is able to destroy thyrocytes and atypical cells of malignant neoplasms of the endocrine organ.

Radioactive iodine treatment is a successful alternative to traditional treatment methods. The advantage of the procedure is the exclusion of radiation exposure to the body as a whole.

Radioactive iodine I-131 is prescribed for the treatment the following diseases glands:

1. Hyperthyroidism caused by increased secretion of hormones - while radioactive iodine neutralizes or suppresses the activity of hypertrophied areas of the organ, selectively destroying those areas that have thyrotoxic properties;
2. diffuse toxic goiter;
3. A malignant process in the gland is follicular or papillary cancer.

Sometimes after treatment, the following unpleasant complications appear:

• sore throat;
• nausea, vomiting;
• neck discomfort;
• increased fatigue;
• sudden flushes of blood;
• inflammatory process in the salivary glands, against which the patient complains of severe pain in the cheeks and
• dry mouth;
• pathologically high growth or, conversely, a drop in hormones in the blood.

Contraindication to radioiodine therapy

is pregnancy.

Women who are expecting a child have an increased risk of developing consequences that can be dangerous for the fetus, provoking malformations in it. During lactation, women should refuse to breastfeed the baby.

With the help of this treatment, there are high chances to get rid of hyperthyroidism, diffuse goiter and oncological pathology without surgical intervention, and there are many advantages to this:

• no need for anesthesia
• there will be no pain
• there will be no postoperative scar.

It is enough just to take the necessary dosage of radioactive iodine, while the force of radiation will not be distributed to the entire body of the patient.

The effectiveness of the treatment can be judged 2 months after the start of the procedure, but there is evidence of faster results.

A physiological decrease in the function of the gland will indicate the cure of hyperthyroidism and recovery - the amount of hormones produced by it will be significantly reduced, sometimes down to another opposite state - hypothyroidism.

One month before the scheduled procedure

a complete rejection of iodine- and hormone-containing drugs is necessary.

A week before the procedure, the waiver of medication applies to all drugs used to treat hyperthyroidism.

Approximately 2 hours before taking radioactive iodine, it is important not to eat or drink any liquid.

Patients of childbearing age should definitely have a pregnancy test done to rule out unnecessary risk.

Immediately before the procedure, a diagnostic is performed, demonstrating how the thyroid gland absorbs iodine.

Based on the data obtained, the doctor selects the required dosage of I-131 for the patient on an individual basis. In case of detection of a malignant process in the endocrine organ, a total resection of the gland is performed.

The tactic is simple: the patient is given several tablets of radioactive iodine, which he must take with clean water.

The active substance of the drug in a physiological way enters the tissues of the gland and begins its action.

As a rule, iodine is localized almost completely in the thyroid tissue of the endocrine organ, including cancer cells, starting its destructive effect.

This mechanism is based on radiation the drug, the depth of action of which remains within 2 mm, it turns out that the isotopes act exclusively in the tissues of the thyroid gland.

If necessary, the drug is offered to the patient in liquid form, while its therapeutic characteristics will remain intact.

For the patient, the use of a radioactive method of treatment, no doubt, is a benefit. But for those who are in contact with him, it is rather harm and an increased risk.

Therefore, for the duration of treatment, the patient is placed in a separate room, or in a room where patients are already receiving similar therapy.

Medical workers will appear in the ward only for manipulations in special protective clothing.

Any patient visits and contacts

with the outside world outside the hospital walls for the duration of treatment are prohibited.

Immediately after the internal use of radioactive iodine, it is recommended to adhere to the following rules:

• exclude contact with strangers;
• do not eat food for at least two hours after the procedure;
• do not limit fluid intake;
• wash your hands frequently with soap;
• after the toilet room, flush twice;
• Rinse your toothbrush with plenty of running water after each use.

A month later, you need to visit a doctor.

The fact is that radioactive iodine can cause hypothyroidism - an insufficient function of the gland.

And this pathology can manifest itself at any moment. Therefore, the state of the endocrine organ must be monitored in dynamics until the amount of hormones in the blood becomes stable.

• exclude sexual life and kissing for at least one week;
• use reliable contraceptives throughout the year;
• stop breastfeeding if it was practiced before treatment with radioactive iodine - then the child should be fed artificially;
• get rid of personal belongings that were used in the hospital, if this is not possible, then put them in a plastic bag and do not touch them for 6 weeks;
• personal hygiene items should be used separately from other family members.

The elimination and half-life of radioactive iodine is 8 days.

That is, there can be no talk of any long-term pollution of the surrounding space. The drug leaves the human body with urine.

If the treatment was chosen correctly and the patient complied with all necessary recommendations, then the probability of recovery approaches 98%.

No deaths have been recorded during the entire existence of radioactive iodine therapy.

In this way, this species treatment has no alternatives, is fast and effective method therapy of pathologies of the endocrine system, including oncological ones.

Treatment of the thyroid gland with radioactive iodine in practice is used by endocrinologists quite often. Its popularity lies in the fact that it has a destructive effect on thyrocytes and atypical cells of malignant thyroid tumors.

Radioiodine therapy is considered a successful alternative traditional methods. The main advantage of this procedure is that it does not cause radiation exposure to the human body.

Description of the method

Treatment of the thyroid gland is carried out using iodine, which has radioactive properties, which in medicine is also called radioiodine and iodine - 131. It is one of the 37 isotopes of iodine - 126, which almost everyone has in their home first aid kit.

The half-life of radioiodine is eight days. Therefore, it has the ability to independently disintegrate in the patient's body. As a result, xenon and 2 types of radiation are formed - gamma and beta.

With good permeability, gamma particles easily penetrate human tissues. To register them, use special equipment. Gamma radiation does not have a therapeutic effect, but, thanks to it, it becomes possible to establish the accumulation of matter. When scanning the body, a specialist can easily find the foci of isotope formation.

Such information is necessary in the treatment of patients diagnosed with thyroid cancer. The appearance of luminous foci after radioiodine therapy makes it possible to establish the presence and location of malignant neoplasms.

Important! the main task therapy consists in the complete destruction of the affected thyroid cells. Positive effect visible 2-3 months after the course. If a relapse occurs, it is possible to repeat the course.

Indications and contraindications for

Treatment with thyroid iodine is possible when the patient has the following pathologies:

The application of the method is also effective in the treatment of nodular toxic goiter and Graves' disease. In the presence of such diseases surgical operation replaced by radioiodine. The use of radioiodine therapy is especially necessary for relapses of the thyroid gland that has already undergone surgery.

Since the development of complications in the postoperative period is quite large, experts prefer radioiodine therapy. Among the contraindications to such a procedure, the period of pregnancy and lactation is distinguished. In the first case, when the fetus is exposed to radioiodine, deviations in its further development are not ruled out. If breastfeeding mothers are treated with radioactive iodine, they should stop breastfeeding their baby.

Pros and cons of radioiodine therapy

Used in thyroid therapy, iodine-131 has several advantages. Among the main ones:

However, despite positive sides, treatment of the thyroid gland with iodine has a number of disadvantages:

In addition, all items and clothing used by the patient at the time of the course must be carefully processed or disposed of.

Preparation for the procedure and features of its implementation

The preparatory phase before taking the isotope must begin 14 days before the start of the course. General recommendations:

1. It is forbidden to lubricate wounds and apply nets. In addition, it is important to refrain from swimming in sea water, visiting salt caves. With permanent residence in the area of ​​sea coasts, isolation from the external environment is necessary for 5-6 days before radioiodine procedures are performed.
2. Women in childbearing age It is mandatory to do a pregnancy test.
3. Refusal of vitamin complexes, drugs and supplements, which contain iodine.
4. Before taking the capsule, a test is done to determine the level of iodine absorption by thyroid tissues. In the case of removal of the gland by the method of the operation, a test is made for sensitivity to the preparation of the lymph nodes and lungs.

Diet Features

In preparation for the passage of radioiodine therapy, it is necessary, first of all, to observe a special diet, the main task of which is to reduce the level of iodine in the body.

Complete rejection of the following products:

It is allowed to use:

• honey, sugar;
• peanut butter;
• egg noodles;
• black pepper and dried herbs;
• veal, lamb meat;
• pasta;
• chicken, turkey;
• carbonated drinks and tea.

The diet does not mean a complete rejection of salt. It is only necessary to use it in a limited amount - up to 8 grams per day.

The principle of the procedure

Radioiodine therapy for thyroid is considered sufficient effective procedure. Its distinctive feature is that a small amount of radioactive material is used, which selectively accumulates in those places where therapeutic intervention is required.

During the session, the patient is given a gelatin capsule containing radioiodine inside. It must be swallowed quickly and washed down with plenty of liquid. In some cases, they can give liquid iodine, after which a thorough rinsing of the mouth is required. In order for the drug to be better absorbed, food and drinks should not be consumed for 60 minutes. After the capsule enters the body, iodine accumulates in the tissues of the thyroid gland. It is excreted through a bowel movement, through urine, sweat or saliva.

After radioiodine therapy, patients, while they are in a separate box, must follow some rules:

• carefully go to the toilet, do not spray urine, after all actions, flush the toilet at least twice;
• after brushing your teeth, rinse the brush well under running water;
• in case of vomiting, use a plastic bag;
• use only disposable handkerchiefs;
• always close the front door;
• flush the used paper in the toilet;
• shower every day;
• if there is no stool, report this fact to the medical staff.

With the complete isolation of the patient, visits are strictly prohibited, since healthy individuals may be exposed to gamma and beta particles.

Which method is better: radioiodine treatment or surgery?

There is still no single answer to this question. Endocrinologists have conflicting opinions. Some believe that it is better to use a thyroidectomy. This is explained on their part by the ability of the patient to lead normal life even after surgery.

Supporters of radioiodine therapy are based on what to treat thyroid gland this method is better, since there is no need for the introduction of anesthesia and the laryngeal nerve is not damaged. The main advantage of using radioactive iodine is that the procedure is painless and non-invasive. In addition, the possible negative consequences. It is hard to say which method is better. The decision of choice is made only by the doctor individually for each case.

Important! If there are no contraindications to radioiodine therapy, then most likely the specialist will advise this particular method of treatment. If the operation is advisable, it is better to listen to the opinion of the doctor and agree to surgical intervention.

After undergoing a course of radioiodine therapy, the patient must follow certain rules:

Also, all patients will be required to undergo an examination by an endocrinologist twice a year during their life and constantly take Thyroxin. All other restrictions are temporary.

The use of radioiodine therapy can provoke some negative consequences. First of all, the development of sialadenitis is not excluded - this is an inflammatory pathology of the salivary glands. The cause of the manifestation is the ingestion of a radioactive isotope in the absence of a remote thyroid gland. In addition, reproductive disorders are also possible. However, such a reaction occurs only in the case of repeated irradiation, the total dosage of which exceeds 500 mCi.

With the right treatment and compliance with all the necessary prescriptions of the attending physician, the probability of recovery is 98 percent.

During the entire period of use of radioiodine therapy, not a single death was recorded. This method considered one of the fastest and most effective in thyroid therapy.

Yakutina Svetlana

Expert of the ProSosudi.ru project

Some diseases require the use of radical methods of treatment. One of them is differentiated thyroid cancer. Ways to deal with the disease differ depending on the mechanism of its development. And one of the effective alternatives to traditional methods of therapy is radioactive iodine. Radioiodine therapy has incomparable advantages, but also many side effects which you should be aware of before starting treatment.

Properties of radioactive iodine

Radioactive iodine (I 131) is an isotope of iodine 126, which is synthesized artificially through the spontaneous decay of atoms. As a result of this process, gamma and beta particles, as well as xenon, are formed. The beta particle formed during the decay of I 131 has the ability to penetrate tissues up to 2 mm, causing the death of pathological cells.

ATC substance code: V10X A01. radiopharmaceuticals.

Radioactive iodine comes in two forms:

• Gelatin capsules, quantity one unit in a metal container
• Solution.

Indications for use

Treatment with radioactive iodine of the thyroid gland is prescribed by a specialist in two cases:

1. If a patient has nodular toxic or diffuse toxic goiter. These conditions are characterized by excessive production of the hormone, resulting in the development of thyrotoxicosis. In the presence of diffuse toxic current, hormones are produced by the tissues of the thyroid gland, and nodular - by the formed nodes. The goal of treatment in such a situation is to suppress the excessive functionality of individual sections of the thyroid gland and normalize its activity.
2. The development of differentiated thyroid cancer, which has the ability to accumulate I 131 in the tumor, destroying it.

The essence of iodine therapy

Treatment with a radioactive isotope of iodine is prescribed for patients in whom the thyroid gland was completely removed before the procedure, but the destruction of metastases and residual tissue is required. Cancer cells left in the thyroid tissue take up iodine from the blood and are destroyed by the effects of beta particles.

The main advantage of using the drug is its directed action. The low penetrating power of beta rays ensures that there is no threat to the tissues surrounding the gland.

Thanks to gamma radiation penetrating through the tissues of the body, with the help of a special camera, the places of accumulation of iodine are fixed. The result indicates the prevalence and location of thyroid cancer metastases.

Preparation for radioiodine therapy

In preparation for treatment with radioactive iodine, patients must be prescribed a special iodine-free diet. Daily intake of iodine is reduced to an amount of no more than 50 mcg. The duration of the diet ranges from one to three weeks before the procedure and 1-2 days after.

When following a diet, it is important to limit the consumption of the following foods: carrots, cabbage, onions, garlic, potatoes, tomatoes. Among animal foods, milk, meat and eggs should be avoided. The undisputed leaders in iodine content are seafood: fish, squid, shrimp, mussels, kelp.

The need for the described diet comes down to the fact that for a certain time the body, including thyroid cancer cells, receives less iodine. Therefore, after a forced “starvation”, cancer cells intensively absorb I 131, which contributes to their destruction.

Radioiodine therapy procedure

The iodine-free diet is followed by the determination of the required dose of the drug, since it is individual for each patient. The dosage depends on the size of the thyroid gland, the rate of absorption of iodine, and the extent of the cancer.

An active iodine capsule is delivered to medical institution after all necessary analyzes in a metal impenetrable test tube and stored in a specially designated safe. The shelf life of the drug is 14 days.

The procedure for taking I 131 is simple - the capsule is swallowed and washed down with a glass of water. After that, it is advisable to rinse your mouth with water, and then swallow it.

After the iodine therapy procedure, it is forbidden to eat for two hours. Drinking, on the contrary, is recommended in plentiful quantities.

The main ways of removing the drug from the body are the gastrointestinal tract, urinary system, sweat and salivary glands. Due to the fact that after taking the medicine, the patient's body emits radiation for some time, the attending physician gives recommendations on further actions.

Procedure contraindications

Despite numerous advantages, treatment with iodine 126 isotope is not indicated for all patients, the exceptions are:

• Pregnancy for more than 12 weeks
• Breast-feeding
• Rheumatism
• myocardial infarction
• Simple goiter in the absence of a violation of the hormonal function of the thyroid gland
• Severe diabetes
• Pulmonary tuberculosis in the active phase
• Renal and liver failure.

Side effects

The use of radioactive iodine in the treatment of differentiated cancer has some backfire. The most common are:

1. Exacerbation of existing chronic diseases- gastritis, cystitis
2. The occurrence of sialadenitis - inflammation of the salivary glands
3. Periodic pain in the tongue and decreased taste sensitivity
4. Dry mouth
5. Weakness, lack of appetite, nausea, vomiting, temporary
6. Sexual dysfunction in case of reusable large doses drug.

Interaction with drugs

When preparing for radioiodine therapy, some preparations containing iodine that interfere with treatment should be abandoned. First of all, you should stop taking levothyroxine - thyroid hormone pills.

Most cough mixtures, expectorants and heart remedies contain iodine, which reduces the effectiveness of the procedure.

From local application iodine is also desirable to refuse 1-2 weeks before the start of the proposed treatment.

The work of the whole organism is completely dependent on the endocrine system. Its largest gland is the thyroid (TG). It is responsible for metabolic rate and growth.

It got its name because of its proximity to the thyroid cartilage. Violations of her work are 4-5 times more common in women, especially after menopause, which indicates a connection with the ovaries. After 45-50 years, the size and level of thyroid hormones decrease in everyone.

It produces 2 hormones - calcitonin and thyroxine - T4. Its share is about 90%. Thyroxine is converted into triiodothyronine or T3. These hormones are produced by the follicular cells of the thyroid gland.

Stimulation of their production is regulated by the pituitary hormone TSH, which stimulates the growth of gland cells (thyreocytes). Special cages(C) The thyroid produces calcitonin, which controls Ca metabolism. Thyroid hormones can only be produced if normal level iodine; he is their basis. The thyroid hormones control and regulate the functioning of all body systems. The gland is responsible for the metabolic rate, pulse rate, heart rate, blood pressure, mood, intelligence and other teeth, muscle tone.

Thyroid dysfunction

They can manifest themselves in the direction of hyper- or hypofunction. Especially these disorders are fraught with children and adolescents, because they cause severe pathologies in the future.

The work of the thyroid gland may depend on the deterioration of the environment; stress; poor nutrition, pathologies of internal organs, pituitary gland, iodine deficiency. Each side of violations has its own clinic.

Hyperthyroidism or increased function

Thyroxine is produced more than normal. Every system in the body works at an increased speed, so the following symptoms appear:

• hell rises;
• pulse quickens;
• there is nausea, diarrhea, increased appetite;
• weight is reduced;
• there is sensitivity to heat;
• there is a tremor of the body and hands, insomnia, mood instability with anger;
• exophthalmos (bulging eyes) develops;
• male potency and MC in women are violated.

Hyperthyroidism is seen in thyroid cancer. In diseases of the thyroid gland with its increased function, RIT is often prescribed.

Hypothyroidism or decreased function

Here the reverse picture occurs - the work of each organ slows down. In children it leads to dementia and stunting; BP goes down; bradycardia appears, emotions are often suppressed, the person becomes slow; there are hormonal disruptions and infertility in women; impotence in men; chilliness; pastosity of the legs, arms, face, swelling of the tongue; hair falls out and grows slowly; slow nail growth; the skin becomes dry; weight increases, and fat is deposited around the abdomen and thighs; appetite decreases and constipation appears.

Hypofunction is observed in every tenth woman. The development of violations occurs gradually, a woman often does not notice this. In women of childbearing age, hypofunction of the thyroid gland increases prolactin and persistently produces estrogen.

The thyroid gland hypertrophies and a goiter appears - a manifestation of hypofunction (endemic goiter). It in the form of a tumor on the front of the neck squeezes the trachea, the voice becomes hoarse; in the throat there is a feeling of a lump and lack of air.

Treatment of hyperthyroidism

Therapy is carried out with the suppression of excess thyroxine production. At the same time, various negative effects are often observed after treatment, so today many doctors are supporters of the use of RIT - radioiodine -131. It often replaces a 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 treated on an outpatient basis (it 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 existing iodine-126 isotopes, which everyone always has in their first aid kit.

Radioiodine is able to completely destroy the affected tissues (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. Both of them have a high penetrating ability in tissues, but beta radiation gives a therapeutic effect. It immediately goes to the glandular tissues around the areas of accumulation of radioiodine.

The penetration depth of these rays is small - only 0.5-2 mm. Moreover, such a range only works within the boundaries of the gland itself.

Gamma particles have no less penetrating power and they pass into any human tissue. They do not have a therapeutic effect, but they help to detect the localization of radioiodine accumulations 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 in surgical treatment.

If a relapse occurs, treatment may be repeated. Therapy with such iodine is carried out only by a highly qualified specialist to exclude side effects.

RIT often becomes the only chance to save a patient diagnosed with differentiated thyroid cancer. The referral for such treatment is not given to every patient due to contraindications.

Indications for the use of radioactive iodine

Indications for iodine treatment may include:

1. Hyperthyroidism with the appearance of benign nodules;
2. Thyrotoxicosis - an extreme degree of thyrotoxicosis with an excess of hormones;
3. Nodular and diffuse toxic goiter (Graves' disease) - these 2 pathologies use RIT instead of surgery;
4. All types of thyroid cancer with the addition of inflammation in the glandular tissue; first of all, these are thyroid carcinomas - a tumor of papillary, medullary and follicular cells of the gland.
5. Metastases of thyroid cancer; RIT is carried out after thyroidectomy.

Treatment of thyroid carcinomas with radioactive iodine makes it possible to completely cure.

Possible contraindications

Contraindications include:

• pregnancy;
• lactation period;
• general serious condition;
• panmyelophthisis;
• severe hepatic and PN;
• stomach ulcer and duodenal ulcer;
• DM in severe form;
• active TB.

The method is well studied, safe and specific precautions have been developed for it. Age restrictions do not give; RIT was also carried out for children aged 5 years.

Pros of RIT

There is no need for anesthesia, there is no rehabilitation period, radiation does not spread to other organs, there is no lethality, scars and scars do not appear. Sore throat after taking the capsule is easily stopped by local action.

Cons of RIT

To plan pregnancy, at least six months must pass after treatment. Better yet, healthy offspring planning should be done 2 years after treatment; development of hypothyroidism. Complications can be in the form of edematous exophthalmos (autoimmune ophthalmopathy). 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, fibromyalgia and fatigue are possible. Possible exacerbation of chronic diseases of the gastrointestinal tract, kidneys; nausea, taste disturbances.

All these disadvantages are easily treated and short-term. The discomfort passes quickly. Increased risk of small bowel cancer; Opponents of RIT are very fond of pointing out the loss of the thyroid gland forever, but is the thyroid gland restored during surgical removal?

The preparatory period for RIT

Lasts an average of a month or a little more. When preparing, you need to increase the amount of TSH that controls the functioning of the thyroid gland. The higher it is, the greater the effect of radiotherapy will be, because cancer cells quickly destroy it.

An increase in TSH can be carried out in 2 ways: the introduction of recombinant TSH (artificial) or the abolition of thyroxine intake a month before the capsule.

This is necessary so that the cells of the thyroid gland become more actively absorb radioiodine. Cancer cells no matter what kind of iodine they absorb. The more they consume it, the faster they die.

Diet in preparation

Nutrition in preparation should also become iodine-free - within 3-4 weeks. It is easy to carry. In practice this vegetarian diet. This requires excluding seaweed and seafood from the diet; dairy; egg yolks; red beans; soy products; Hercules; grapes, persimmons and apples; semi-finished products.

Food should not be food additive E127 - red food coloring - it is added to canned meat, salami, canned fruit with cherries and strawberries; candies and marshmallows Pink colour. Use regular salt, without iodine. The diet will not only relieve the body, but the body recovers faster after taking the capsule.

The process of radioiodine therapy

In the treatment, most often the capsule is taken once, rarely in the form of a course. The attending physician selects the capsule in the right dose after diagnosis. It is prepared individually. After swallowing the capsule, a 5-day medical observation is desirable. It needs strict isolation. On the day the capsule is taken, food should not be taken 2 hours before and after taking.

Fluid intake should be increased. It helps to remove the isotope from the body. Isolation of the patient without a visit with taking the capsule is necessary, because. the body, although weakly, emits radioactive radiation. All belongings and belongings of the patient are optimally eliminated in compliance with radiation protection measures. Bed linen should be changed daily; the toilet after each visit is also processed.

Tips for isolation:

• wash and change clothes daily;
• drink acidic drinks and chew gum to increase saliva production;
• every 2-3 hours to visit the toilet;
• use disposable tableware;
• any devices near the patient, cover with polyethylene or use rubber gloves;
• distance with the patient at least 3 m.

3 days after the treatment with radioactive iodine of the thyroid gland (taking the capsule), at the appointment with the endocrinologist, the degree of iodine exit from the body is checked by scanning in a gamma camera. If there is still a lot of it, the isolation is extended. A month later, hormonal treatment is prescribed.

Side effects

Treatment with radioactive iodine (radioiodine therapy) of the thyroid gland and the consequences are not comparable in degree. The efficiency of the RIT method is high - 98%; no deaths have been registered. Side effects and the effects of radioactive iodine treatment are short-lived, but they need to be known.

It's a tingle in the tongue; sore throat; dry mouth; nausea; swelling in the form of slight swelling on the neck; change in taste sensations. Panic fear of patients before, allegedly, radiation to the whole body during RIT is unfounded.

Radioactive iodine - non-surgical treatment of the thyroid gland - an alternative to surgical intervention. There are no methods equal to this method. Moreover, chemotherapy does not help with thyroid cancer.

06.06.2014

Radioactive iodine, used to treat the thyroid gland, is recognized safe method, which is no less efficient than traditional ways. The iodine isotope I-131 has a unique ability to destroy thyroid cells, while there is no general radiation effect on the body. Treatment consists in taking the drug, the dose of which is calculated individually. The essence of the method is radiation, the range of which does not exceed 2 mm, so the isotope affects only the tissues of the thyroid gland that can accumulate iodine.

Indications for use

• Hyperthyroidism - an increase in the hormonal activity of the thyroid gland with benign formations
• Thyrotoxicosis - intoxication as a result of excessive secretion of gland hormones
• Malignant neoplasms

The therapeutic effect after treatment with radioactive iodine occurs no earlier than 2-3 months with a favorable course. Therefore, the success of the therapy is judged, as a rule, six months after RIT. But it is impossible to foresee the time of the onset of the effect in advance - in some patients it may occur after taking the first dose, for others it is necessary to repeat the procedure.

In most cases, the outcome is hypothyroidism - a decrease in gland function, then therapy is prescribed to compensate for a possible lack of hormones. Life after radioactive iodine in such patients proceeds without discomfort and inconvenience.

As a result of many years of research, there are:

• acute, deterministic (non-stochastic) effects
• long-term, probabilistic (stochastic) consequences of radioactive iodine treatment

Deterministic Effects

As a rule, a pronounced reaction after the procedure is not observed in most patients. Acute events are short-lived and often resolve on their own.

• Some patients may experience discomfort, swelling in the neck, pain when swallowing. 1% of patients have allergic reactions for iodine in the form skin manifestations, slight increase temperature.
• In 10% of patients, the effects of radioactive iodine are manifested by inflammation of the lacrimal and salivary glands. Sucking on lollipops can help relieve the condition.
• A third of patients are concerned about lack of appetite, nausea, vomiting, gastritis phenomena, which are completely regulated by diet and the use of special drugs.
• 25% of women experience amenorrhea and dysmenorrhea in the first couple of months. Studies have shown that the procedure does not affect either the ability to bear children or the health of the unborn child. The only limitation is that pregnancy after radioactive iodine treatment should be excluded in the first six months, in some cases a year. In men, oligospermia may occur, but potency does not suffer.
• Post-radiation cystitis is a rather rare phenomenon, easily corrected by increased diuresis.
• Aplasia, hypoplasia, pancytopenia - these phenomena pass on their own

Particular attention should be paid to patients with an exacerbation of thyrotoxicosis, which may occur during the first two weeks. But the danger of such a phenomenon can be prevented with a competent combination of RIT with antithyroid drugs.

Long-term effects

Long-term effects (mutagenic, carcinogenic, genetic) after exposure to ionizing radiation are not so common. They occur, as a rule, in children conceived during the period of treatment by the patient. Nevertheless, the role of radiation and the likelihood of developing long-term consequences should neither be exaggerated nor underestimated - the unfavorable radiation situation is a risk factor, and the cumulative effect has yet to be studied. Although a number of studies have cast doubt on the carcinogenic effect of radioactive iodine, the result of treatment is the replacement of thyroid cells connective tissue. In this case, there are no conditions for the development of a malignant tumor.

This modern, effective and used worldwide method of treatment has many advantages. Feeling much better after radioiodine therapy. Of course, it is sometimes difficult for an ordinary patient who does not have special knowledge to understand the mass of information. Therefore, with any questions, you should consult a doctor.