Irradiation of the thyroid gland with radioactive iodine. Treatment with radioactive iodine. What is radioiodine therapy

Radioactive iodine, which is used in medicine, is an isotope of iodine I-131. Treatment radioactive iodine in Moscow are carried out in many clinics. It has a unique ability to destroy thyrocyte cells of the thyroid gland and malignant tumor cells. In this case, the total radiation exposure to the entire body is not created. When is radioactive iodine treatment appropriate? What rules must be followed when conducting it? These and other questions will be discussed in today's article.

Thyroid treatment with radioactive iodine

The use of iodine I-131 helps with therapy:

hyperthyroidism - increased hormonal activity of the thyroid gland, caused by the occurrence of benign nodes;
thyrotoxicosis - intoxication, which causes a persistent increase in the production of thyroid hormone.

They also treat cancer with radioactive iodine.

Possible complications of the use of radioactive iodine

In some cases, there may be side effects, you need to know about them if you plan to treat with radioactive iodine. Reviews of patients who used this therapeutic technique indicate various complications that appear:

inflammation salivary glands, which provokes dry mouth and sore cheeks;
metallic taste in the mouth;
sore throat;
neck pain
nausea, vomiting;
fatigue;
flushes of blood;
abnormally high and abnormally low levels of thyroid hormones.

Contraindications

Treatment with radioactive iodine should not be carried out during pregnancy. Pregnant women are at increased risk of developing serious complications, the procedure may harm the fetus. Breastfeeding mothers should avoid breastfeeding baby.

The use of radioactive iodine in thyrotoxicosis and hyperthyroidism

Getting rid of thyrotoxicosis or hyperthyroidism with the help of radioactive iodine is much safer and easier than by surgical intervention: there is no need to endure painful sensations, the effect of anesthesia, get rid of unaesthetic scars, you just need to drink a certain dose of iodine 131.

The dose of radiation received even in large quantities of I-131 does not apply to the entire body of the patient. An approximate radiation dose has a permeability of 2 mm. Thyroid treatment with radioactive iodine positive results 2-3 months after the start, although there are cases of more quick effect. Complete recovery is indicated by a significant decrease in the production of thyroid hormones.

Preparation for treatment

The doctor may recommend a special diet to improve the effectiveness of treatment.
A month before the procedure, you should stop taking hormonal drugs. For 5-7 days, it is necessary to abandon the use of other medicines used to treat hyperthyroidism.
2 hours before the procedure, it is recommended to exclude food and drink (except clean water).
For a woman of childbearing age, a doctor must conduct a pregnancy test.
Before starting treatment, an analysis is made for the absorption of iodine by the thyroid gland. Based on the results of this study, the desired dose of I-131 is calculated. If a malignant tumor is detected, complete removal thyroid gland.

What is the essence of the procedure

Treatment with radioactive iodine is as follows. The patient receives several tablets containing radioactive iodine, he will have to swallow them with 1-2 glasses of pure water (not juice). Iodine naturally penetrates the thyroid gland. AT exceptional case a specialist may prescribe a liquid form of radioiodine that has similar characteristics. In this case, after taking the medicine, rinse your mouth thoroughly with water and swallow it immediately. If the patient wears removable dentures, they will be advised to remove them before using liquid iodine.

How dangerous is radioactive iodine to others

Radiation used for treatment brings tangible benefits to the patient. However, for those who come into contact with him, it is harmful. To reduce the risk of radiation exposure to others, the patient will be placed in a separate room or a room with patients with a similar disease. Medical staff will be able to stay in the room with such patients only for the duration of the procedure. necessary procedures and will have to protect himself with special clothing and gloves.

Is it possible to receive visitors

After taking radioiodine, all visitors are excluded. That is, the patient will not be able to have any physical contact with other people. Communication is possible only through the medical staff. It is forbidden to transfer anything outside the medical facility, including leftover food, drinks, clothing, printed materials.

Actions after radioiodine treatment

After treatment with radioactive iodine, certain recommendations should be followed:

For at least two hours after using radioactive agents, do not consume solid food. It is recommended to drink plenty of fluids.
Limit contact with other people. Do not enter the premises with children. Stay at least 3 meters away from other people. You should not be near another person for more than a few minutes. Within 48 hours after the use of radioactive drugs, you should not sleep next to other people.
After using the toilet, double flush the water.
Wash your hands thoroughly and often with soap.
Be sure to thoroughly wash your toothbrush after each use.
When vomiting, use plastic bags or a toilet bowl and be sure to notify the staff on duty.
Do not use reusable cloth handkerchiefs, you must have paper disposable napkins.
It is recommended to take a shower daily.
The entrance door to the room must always be closed.
It is forbidden to feed through open windows animals and birds.
48 hours after the procedure, it is allowed to resume taking thyroid medications.

After 4-6 weeks of treatment, a visit to the doctor is required. The use of radioactive iodine can provoke hypothyroidism (low function of the thyroid gland). Such a disorder can occur at any time after treatment. The thyroid gland should be checked every few months until hormone levels stabilize.

Patients treated with radioactive iodine should adhere to the following rules after discharge:

At work or at home, try to stay at least one meter away from others.
During the first week of therapy, avoid kissing and sexual intercourse.
Be sure to use the most appropriate means of contraception (women for 6-12 months, men - at least in the first 2 months). Additionally, you can consult with your doctor about this.
If, before the use of radioactive iodine, a woman breast-fed a child, after therapy, lactation is stopped, the baby is transferred to artificial nutrition.
All personal clothing used during a hospital stay is washed separately, placed in a separate plastic bag and not used for a month and a half.
For faster cleaning salivary glands from radioactive iodine, it is recommended to use sour sucking sweets, lemon, chewing gum as often as possible.
After discharge from the medical facility, radioactive iodine will continue to be excreted in small amounts. That's why bed sheets, towels, washcloths, cutlery must be strictly individual. In this case, there is no need to separately wash the things of the patient.

Remember that for any questions regarding treatment or recovery period you can always consult with your doctor.

Treatment with radioactive iodine: the cost of the procedure

Radioiodine therapy is carried out in many clinics in Russia and other countries. Treatment with radioactive iodine in Moscow will cost approximately 45-55 thousand rubles.

Conclusion

Learn more about radioactive iodine treatment in this article. Reviews about this therapeutic technique both patients and doctors leave predominantly positive. But the treatment, of course, is prescribed strictly on an individual basis by a highly qualified specialist. Be healthy!

Bad ecology, stress and other adverse conditions often lead to thyroid diseases. Its increase harms the body. Thyrotoxicosis can take the most different forms, including diffuse toxic goiter, also called Graves' disease or Graves' disease. Sometimes it even leads to thyroid cancer. To destroy the overgrown tissue of the gland and radioactive iodine is called upon.

Thyroid disease

Thyrotoxicosis, which is hyperthyroidism, can take many forms. These include diffuse and Plummer's disease, Hashimoto's goiter and some other ailments. Treatment with radioactive iodine successfully copes with these diseases (in Moscow it is carried out, for example, in TsNIIRRI and some other clinics). This method is complemented by the treatment of many types of cancer and other tumors of the thyroid gland, including lymphoma and Hashimoto's thyroiditis.

The opposite of thyrotoxicosis is hypothyroidism, which does not pose a serious threat and is corrected with drugs. In addition to diseases of the thyroid gland itself, sometimes there is a deficiency or hyperfunction parathyroid glands, i.e. hypoparathyroidism and hyperparathyroidism. Deficiency is treated with medication, but hyperfunction requires surgery.

Therapy for thyrotoxicosis and cancer

Majority similar diseases effectively eliminates radioactive iodine treatment. This type of therapy is also carried out in Moscow. Of course, conservative treatment is prescribed first, say, toxic adenoma or diffuse toxic goiter with the help of medications. But the efficiency rarely exceeds 40%, and often almost half as much. If a similar treatment does not bring results or there is a relapse, then the best solution would be to prescribe therapy with radioactive iodine I 131. Radiation can also be used, but it increases the risk of cancer of the gland, and iodine remains harmless.

The cancer is removed promptly. But even in this case, radioactive iodine treatment in Moscow, as well as throughout the world, is carried out as additional method therapy. It is important here to meet the deadlines after thyroidectomy and to treat according to the protocol, then the risk of metastases can be minimized.

Why not an operation?

Sometimes an alternative therapy for thyrotoxicosis is surgical intervention. Of course, the operation is always associated with great 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 - all these are factors that speak against surgery in favor of a more gentle, but effective radioiodine therapy. Of course, in some cases, without emergency measures just can not do, as in the case of cancer.

At surgical method often retained part of the tissue to prevent hypothyroidism. However, this approach is fraught with recurrence of the disease. Thyroid-stimulating autoimmune antibodies again attack the remnants of the gland, leading to a new round of the disease. Therefore, now they prefer to get a full therapeutic effect instead of a temporary one. And the cost of radioactive iodine treatment is more acceptable.

World practice

Mild forms of the disease are preferred 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 various antithyroid drugs more than radioactive iodine treatment. But in the United States, preference is given to radioiodine therapy as more effective. Of course, after it you need to go through a rehabilitation program, but taking medication also requires further recovery of the body.

The first introduction of radioisotopes of iodine was carried out in 1941 in the USA. And since 1960, the method has been widely used in medicine. Per past period convinced of its usefulness, reliability and safety. And the price of radioactive iodine treatment has become more affordable. In some clinics in America and Europe, treatment with small doses of iodine is already being carried out on an outpatient basis. We also allow such a regimen, but only for doses within 10.4 mCi in terms of activity. Abroad, the norms are somewhat different, allowing more strong 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 just allows for treatment. It emits ß- and ɣ-particles. ß-radiation produces an irradiating effect localized in the tissues of the thyroid gland. ɣ-radiation allows you to control the dose and distribution of the drug. Thyroid accumulates this radioisotope of iodine I 131, and it, in turn, damages the thyroid tissue, which is the therapy for thyrotoxicosis.

Safety for other tissues is explained by the fact that it binds iodine isotopes and attracts them to itself. In addition, its half-life is only 8 days. The intestinal and urinary systems capture, as a rule, a minimum of the isotope, without exceeding the permissible limits. The cytotoxic effect is localized, destroys only thyrocytes, which leads to a decrease in the thyroid gland in volume and the transition to hypothyroidism without surgical intervention.

Hypothyroidism, in turn, is corrected with 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 the endogenous one. Control over the level of hormones, no doubt, is necessary, sometimes the dosage needs to be changed, but otherwise, patients return to their usual way of life.

Purpose of treatment

Now even our experts are inclined to believe that it is necessary to carry out a single treatment with radioactive iodine in Moscow or other cities in order to cause the development of hypothyroidism. Treatment with small doses simply reduces the symptoms, removes the problem only for a while, 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 routine of scintigraphy.

First, an examination is carried out, clarified comorbidities, calculations are made. Sometimes a decision is made to perform two injections of the drug to achieve the desired result. But there are cases when surgery is more appropriate.

Cancer is also treated with radioactive iodine, but already as a second stage of therapy. The dosages here are higher, aimed at eliminating the risk of developing metastases. The amount of the drug depends on the severity of the case and the prevalence of the process. Outpatient this procedure do not perform, preferring to leave the patient for two or three days in the clinic.

The consequences of taking the drug

You should be prepared for what will happen after treatment with radioactive iodine. For several days after taking the drug, radioactive iodine will leave the body through saliva and urine. These symptoms may last different period time, which depends on age and prescribed dose. At the same time, the elimination process is accelerated in young people, compared with the situation in the elderly.

It has practically no effect on well-being. Only a few sensitive people who have undergone radioactive iodine treatment report nausea during this period. You may also experience dry mouth or pain in your neck and throat. Celebrate increased fatigue and metallic taste in the mouth. Sometimes it can cause constipation or diarrhea.

Restrictions after treatment

But at the same time there are a number of restrictions that are instructions for action. So, certain period time it will be necessary to avoid close contact with other people in order not to irradiate them. You will have to sleep alone, refuse kisses and hugs, avoid sharing dishes and follow similar measures. In this regard, a number of prescriptions for the behavior of the patient can be distinguished.

Patients undergoing radioactive iodine treatment, reviews confirm this, should pay more attention to hygiene for some time. So, it is better to flush the toilet twice, wash your hands after visiting it especially carefully in plenty of water and soap. Will be needed separate dishes, towels, bed linen, which no one else will use. Naturally, linen and clothes should also be washed separately from the belongings of relatives. Do not prepare food for the household.

It is better to collect even garbage in a separate basket, and then give it to a medical institution for disposal (if such a service is provided). Otherwise, you can throw it in a regular trash can after 8 days. The dishes should not be washed together with other people's items, it is better to wash them by hand without dishwasher. Disposable plates and utensils are all placed in the same separate trash bag.

All chemical elements form isotopes with unstable nuclei, which emit α-particles, β-particles or γ-rays during their half-life. Iodine has 37 types of nuclei with the same charge, but differing in the number of neutrons that determine the mass of the nucleus and the atom. The charge of all isotopes of iodine (I) is 53. When they mean an isotope with a certain number of neutrons, write this number next to the symbol, through a dash. AT medical practice use I-124, I-131, I-123. The normal isotope of iodine (not radioactive) is I-127.

The number of neutrons serves as an indicator for various diagnostic and therapeutic procedures. Radioiodine therapy is based on different duration half-life of radioactive isotopes of iodine. For example, an element with 123 neutrons decays in 13 hours, with 124 - in 4 days, and I-131 will radioactive action after 8 days. More often, I-131 is used, during the decay of which γ-rays, inert xenon and β-particles are formed.

The effect of radioactive iodine in the treatment

Iodine therapy is prescribed after the removal of the thyroid gland completely. With partial removal or conservative treatment this method is useless. The follicles of the thyroid gland receive iodides from the tissue fluid that surrounds them. Iodides enter the tissue fluid by diffusion or by active transport from the blood. During iodine starvation, secretory cells begin to actively capture radioactive iodine, and degenerate cancer cells do this much more intensively.

β-particles, released during half-life, kill cancer cells.

The striking ability of β-particles acts at a distance of 600 - 2000 nm, this is quite enough to destroy only cellular elements malignant cells rather than neighboring tissues.

The main goal of radioiodine therapy is the final removal of all remnants of the thyroid gland, because even the most skillful operation leaves behind these remnants. Moreover, in the practice of surgeons, it has already become customary to leave several gland cells around the parathyroid glands for their normal operation, as well as around the recurrent nerve that innervates the vocal cords. The destruction of the iodine isotope occurs not only in the residual tissues of the thyroid gland, but also metastasis in cancerous tumors, which makes it easier to monitor the concentration of thyroglobulin.

γ-rays do not have a therapeutic effect, but they are successfully used in the diagnosis of diseases. The γ-camera built into the scanner helps to determine the localization of radioactive iodine, which serves as a signal for recognition cancerous metastasis. The accumulation of the isotope occurs on the surface of the front of the neck (in place of the former thyroid gland), in the salivary glands, along the entire length digestive system, in the bladder. Few, but still there are iodine uptake receptors in the mammary glands. Scanning reveals metastases in trimmed and nearby organs. Most often they are found in the cervical lymph nodes, bones, lungs and tissues of the mediastinum.

Treatment prescriptions for radioactive isotopes

Radioiodine therapy is indicated for use in two cases:

If the state of a hypertrophied gland is detected in the form of a toxic goiter (nodular or diffuse). State diffuse goiter characterized by the production of thyroid hormones by the entire secretory tissue of the gland. At nodular goiter only the tissue of the nodes secretes hormones. The tasks of introducing radioactive iodine are reduced to the inhibition of the functionality of hypertrophied areas, since the radiation of β-particles destroys precisely those places that are prone to thyrotoxicosis. At the end of the procedure or restored normal function glands, or hypothyroidism develops, which is easily brought back to normal with the use of an analogue of the hormone thyroxine - T4 (L-form).
If found malignant neoplasm thyroid gland (papillary or follicular cancer), the surgeon determines the degree of risk. In accordance with this, risk groups are distinguished according to the level of tumor progress and possible distant localization of metastases, as well as the need for radioactive iodine treatment.
The low-risk group includes patients with a small tumor, not exceeding 2 cm and located in the outline of the thyroid gland. No metastases were found in neighboring organs and tissues (especially in the lymph nodes). Such patients do not need to inject radioactive iodine.
Patients at intermediate risk have a tumor larger than 2 cm but not larger than 3 cm. poor prognosis and the capsule germinates in the thyroid gland, a dose of radioactive iodine of 30-100 mCi is prescribed.
Group with high risk has a pronounced aggressive nature of the growth of a cancerous tumor. There is germination in neighboring tissues and organs, lymph nodes, there may be distant metastases. Such patients require treatment with a radioactive isotope greater than 100 millicuries.

Radioiodine Administration Procedure

The radioactive isotope of iodine (I-131) is synthesized artificially. It is taken in the form of gelatin capsules (liquid) orally. Capsules or liquid are odorless and tasteless, swallowed only with a glass of water. After taking the liquid, it is recommended to immediately rinse your mouth with water and swallow it without spitting it out.

In the presence of dentures, it is better to remove them for a while before using liquid iodine.

You can’t eat for two hours, you can (even need to) take plentiful drink water or juice. Iodine-131, not absorbed by the thyroid follicles, is excreted in the urine, so urination should occur every hour with the control of the content of the isotope in the urine. Medicines for the thyroid gland are taken no earlier than 2 days later. It is better if the patient's contacts with other people at this time are strictly limited.

Before the procedure, the doctor must analyze the taken medicines and cancel them in different time: some of them - a week, others at least 4 days before the procedure. If a woman is in childbearing age, then pregnancy planning will have to be postponed for a period determined by the doctor. Previous surgery requires a test for the presence or absence of tissue capable of absorbing iodine-131. 14 days before the start of the introduction of radioactive iodine is prescribed special diet, at which the normal isotope of iodine-127 must be completely eliminated from the body. The list of products for the effective removal of iodine will be prompted by the attending physician.

Treatment of cancerous tumors with radioactive iodine

If the iodine-free diet is correctly observed and the period of restrictions on the intake of hormonal drugs is observed, the thyroid cells are completely cleared of iodine residues. With the introduction of radioactive iodine against the background of iodine starvation, cells tend to capture any isotope of iodine and are affected by β-particles. The more actively cells absorb a radioactive isotope, the more they are affected by it. The dose of irradiation of thyroid follicles that capture iodine is several tens of times greater than the effect of a radioactive element on surrounding tissues and organs.

French experts have calculated that almost 90% of patients with lung metastases survived after treatment with a radioactive isotope. Survival within ten years after the application of the procedure was more than 90%. And these are patients with the last (IVc) stage of a terrible disease.

Of course, the described procedure is not a panacea, because complications after its use are not excluded.

First of all, it is sialadenitis (inflammation of the salivary glands), accompanied by swelling, soreness. This disease develops in response to the introduction of iodine and the absence of thyroid cells capable of capturing it. Then the salivary gland has to take over this function. It should be noted that sialadenitis progresses only at high radiation doses (above 80 mCi).

There are cases of violation of the reproductive function of the reproductive system, but with repeated exposures, the total dose of which exceeds 500 mCi.

Treatment after thyroidectomy

Often, cancer patients are prescribed iodine therapy after removal of the thyroid gland. The objective of this procedure is the final defeat of cancer cells remaining after the operation, not only in the thyroid gland, but also in the blood.

After taking the drug, the patient is placed in a single room, which is equipped in accordance with the specifics.

Medical personnel are limited to contact for up to five days. At this time, visitors should not be allowed into the ward, especially pregnant women and children, in order to protect them from the flow of radiation particles. Urine and saliva of the patient are considered radioactive and are subject to special disposal.

Pros and cons of radioactive iodine treatment

The described procedure cannot be called completely “harmless”. So, during the action of a radioactive isotope, temporary phenomena are noted in the form pain in the region of the salivary glands, tongue, front of the neck. The mouth is dry, itchy in the throat. The patient is nauseated, observed frequent urges to vomiting, puffiness, food becomes not tasty. In addition, the old chronic diseases, the patient becomes lethargic, quickly tired, prone to depression.

In spite of negative points treatment, the use of radioactive iodine is increasingly used in the treatment of thyroid gland in clinics.

The positive reasons for this pattern are:

there is no surgical intervention with cosmetic consequences;
general anesthesia is not required;
the relative cheapness of European clinics compared to operations with a high quality of service and scanning equipment.

Danger of radiation on contact

It should be remembered that the benefit provided in the process of using radiation is obvious to the patient himself. For the people around him, radiation can play bad joke. Not to mention the sick's visitors, let's mention that medical workers care only when necessary and always wear protective clothing and gloves.

After discharge, you should not be in contact with a person closer than 1 meter, and with a long conversation, you should move 2 meters away. In the same bed, even after discharge, it is not recommended to sleep in the same bed with another person for 3 days. Sexual contacts and being near a pregnant woman are strictly prohibited within a week from the date of discharge, which occurs five days after the procedure.

How to behave after irradiation with an isotope of iodine?

Eight days after discharge, children should be kept away from themselves, especially contact. After using the bathroom or toilet, flush three times with water. Hands are washed thoroughly with soap.

It is better for men to sit on the toilet when urinating to prevent splashing of radiation urine. Breastfeeding should be discontinued if the patient is a nursing mother. The clothes in which the patient was on treatment are placed in a bag and washed separately a month or two after discharge. Personal belongings are removed from common areas and storage. When emergency call to the hospital, it is necessary to warn the medical staff about the recent course of exposure to iodine-131.

The number of visits to doctors malignant tumors thyroid in last years does not decrease, but only increases. Moreover, among patients there are more and more often not only mature people, but also the younger generation, who also have thyroid diseases. Neoplasms are predominantly quite aggressive, they have early metastasis, which inevitably reduces the chances of people for a favorable outcome.

At complex treatment thyroid disease, a popular method is radioiodine therapy, which gives nice results and greatly improves prognosis when thyroid cancer is diagnosed. After applying the method, the chances of getting rid of metastases increase, as well as increase the remission period. Understand what radioiodine therapy is and what are the benefits this method in general and regarding treatment.

What is radioiodine therapy

Radioiodine therapy is the use of radioactive iodine, which medical terminology also called radioiodine I/131. This type Iodine is one of the 37 isotopes of iodine-126, which can be found in any first aid kit.

During use, radioiodine, which has a half-life of 8 days, spontaneously dissolves in the human body. There is the formation of xenon, as well as radioactive types of radiation, such as gamma and beta radiation.

Therapeutic effect is achieved due to the flow of particles of the “beta” type (or fast electrons), one of the properties of which is an increased penetrating ability into body tissues located near iodine accumulation due to a good outgoing speed. Beta particles penetrate 0.5-2 mm deep. And since the radius of their work is limited only by these figures, iodine performs its functions only within the thyroid gland.

Gamma particles also have good permeability, which ensures their passage into any human tissue. To register them you need special equipment, special chambers. There is no therapeutic effect from “gamma” particles, but radiation makes it possible to detect iodine accumulation sites. When scanning human body using a gamma camera, the doctor easily determines the isotope formation zone.

This information is very valuable for cancer patients, since the identified foci that appeared after radioiodine therapy help to talk about the presence of malignant metastases.

The main goal of therapy is to completely get rid of the affected tissues of the thyroid gland.

The effect can be expected several months after the start of treatment. For those who are faced with a relapse of the pathology, a repeated therapeutic course is often prescribed so that the thyroid gland disease ceases to bother the patient.

Indications and contraindications

Radioiodine therapy is indicated for people suffering from:

increased activity of the thyroid gland, in which benign nodular neoplasms occur ();
a condition whose feature is an excess of thyroid hormones, and which is a consequence;
all types of thyroid cancer, which are characterized by the appearance of malignant neoplasms in the tissues of the diseased organ, with the presence of an inflammatory process;
distant metastases that are able to selectively "accumulate" the isotope.

The treatment of thyroid cancer by this method is due to the insignificant effect of iodine on other organs.

If the goal is to treat thyroid cancer, when it makes sense to get rid of organ tissue that is present after surgery or when affecting the lymph nodes and other parts of the body, iodine therapy is also used.

The radioactive type of treatment offers the opportunity to improve the survival of patients with other forms of cancer, such as follicular and papillary. Treatment of thyroid cancer in these cases is quite standard practice.

For the treatment of thyroid cancer to bring the maximum effect, the patient must have high rate thyroid-stimulating hormone levels in the blood. It increases the absorption of incoming iodine by diseased cells.

Also, the method is justified in case of recurrence of the pathology, when the operation has already been performed and the thyroid gland has been removed. Most often they happen when a type is deleted.

Postoperative complications are high percent probabilities. For this reason, many professionals are increasingly opting for radioactive iodine treatment.

The considered method is categorically contraindicated in:

pregnancy, since fetal malformations after exposure are not excluded;
breastfeeding.

Pros and cons of the procedure

If we compare the procedure for treating the thyroid gland with radioactive iodine with an operation, it has certain advantages:

there is no need for anesthesia;
no severe postoperative period;
scars and scars in the neck area are excluded;
a portion of iodine is taken once, possible discomfort after treatment, they are quite easily eliminated when using topical drugs;
a large proportion of the radiation received during the procedure falls on the thyroid gland, only a small part falls on neighboring organs;
the dose of exposure is determined in each case individually and depends on the type of disease;
there is no threat to life, as, for example, with repeated surgical intervention.

It is important to note the disadvantages of therapy:

small doses of iodine can accumulate in female body, for example, in the epididymis, mammary glands or ovaries. Men have cases of accumulation in the prostate;
there are examples of deterioration in vision and development;
sometimes patients report excessive fatigue, muscle pain, changes in weight;
exacerbated chronic diseases;
taste sensations change, nausea and vomiting appear;
after undergoing the procedure, you will have to spend several days in isolation, since the body will emit radiation that is dangerous to others.

Which is preferable: surgery or radioactive iodine?

Opinions on this issue differ even among specialists who have been practicing thyroid treatment for many years.

Some strictly adhere to the opinion that after an operation to remove the thyroid gland, a person who takes a lot of drugs can continue to lead his usual lifestyle.

Supporters of radioiodine therapy of the thyroid gland argue that there are no significant side effects that will inevitably be encountered during surgery.

There are experts who greatly exaggerate, saying that therapy can lead to the full functioning of the thyroid gland. But this statement is highly erroneous, because therapy is characterized by complete suppression of the work of the organ.

Thus, both therapeutic approaches are reduced to achieving an identical goal. Therefore, you will have to choose in each case individually, listening to the advice of a specialist whom you trust with your own health. Radioactive iodine is good because there are no pain, invasiveness. There is no risk of complications that are possible after surgery.

Preparatory measures before therapy

Prepare to receive the isotope is half a month before the start of treatment.

prevent the ingress of iodine skin surface before therapy. You can not use the tool in the treatment of wounds and cuts, make an iodine mesh;
don't visit salt caves don't swim in sea water, do not travel to places with sea air saturated with iodine;
cancel appointment vitamin complexes, additives, medicines that contain hormones or iodine;
women to exclude the possibility of pregnancy;
before taking capsules with a substance, it is worth doing a test showing the absorption of radioactive iodine by thyroid tissues.

If there was surgery to remove the gland, it is worth conducting a test to determine the sensitivity to iodine on the part of the lymph nodes and lungs, since it is they who perform the accumulative function of iodine in this group of patients.

Iodine free diet before radioiodine therapy

If the decision to conduct therapy has already been made, it is worth considering dietary adjustments, the use of an iodine-free diet. Foods that contain a large number of iodine.

It is forbidden to use, when using an iodine-free diet:

seafood, algae and seaweed;
milk products, egg yolks;
products containing soy;
citrus varieties of fruits, like apples, grapes and persimmons;
red beans;
Hercules;
products containing food red food coloring.

During the iodine-free diet, the menu may look like this:

about 150 grams of meat per day;
about 200 grams of cereal or porridge;
allowed 200 grams pasta per day, not containing eggs;
vegetables and fruits, except for those that are not prohibited by the diet;
nuts;
honey or sugar;
herbal seasonings;
salt that does not contain iodine;
vegetable oils;
tea, in a small amount coffee.

An iodine-free diet before radioiodine therapy can look quite simple and delicious at the same time. The menu of the iodine-free diet for a specific day is compiled in such a way that the diet is as complete as possible. The day usually starts with porridge, sweet tea and fruit.

For lunch, it makes sense to cook vegetable soup, boiled meat with a side dish, some unleavened bread, compote. For dessert, honey with nuts is allowed. A good dinner option, if you follow an iodine-free diet, can be a piece of lean fish and vegetables, as well as tea with jam.

Treatment procedure after thyroidectomy

The procedure in question is often done on cancer patients who have already undergone surgery to remove the gland. The main goal of treatment is the complete elimination of anomalous type cells that could remain in the area of the removed thyroid gland and in the blood plasma.

The person who took the drug is located in an isolated ward, which is equipped based on the characteristics and specifics of the treatment. Staff contact the patient only when absolutely necessary or for procedures. Treatment after radioiodine therapy includes a number of simple recommendations.

Individuals treated with radioactive iodine should:

to accelerate the withdrawal of decay products of the main active substance, drink enough liquids;
wash as often as possible;
use personal hygiene items;
when using the toilet, flush twice;
try not to have close contact with children: do not hug, do not pick up. It is temporarily worthwhile to completely exclude contact with babies;
the first few days after discharge, it is worth sleeping alone, minimizing close contacts with healthy people;
do not communicate with pregnant women for the first week after discharge;
when hit in medical institution immediately inform staff that there has already been radioactive iodine treatment;
take thyroxin for life, as well as visit an endocrinologist 2 times a year.

In all other respects, life will be the same as before the treatment. The above conditions will be only for a short time after radioiodine therapy of the thyroid gland.

Effects

Treatment with radioactive iodine often causes deterioration of the thyroid gland, so hypothyroidism does not develop. Insufficient amount of hormones given period time must be restored with medication. When the level of hormones has been restored, then you can live without restrictions and limits, except for the situation when the organ is completely removed.

Studies have shown the possibility of some unpleasant consequences after treatment for thyroid disease:

acute symptoms of deterministic effects;
often imperceptible to a person or distant effects that appear after a certain time period. At first sight good health after a course of treatment does not guarantee side effects.

Acute side effects

When radioactive iodine treatment is completed, the condition is usually present general intoxication. It manifests itself in the form of vomiting, nausea. The patient may have a fever, he is quite weak, pain in the muscles is felt.

The described symptoms are quite individual and disappear within 2-3 days after therapy. If the condition is too tense, you can take drugs to relieve unpleasant symptoms to rid the body of intoxication.

Common side effects are swelling, tension in cervical area, painful swallowing. This condition is a consequence of the action of radioiodine on the remains of the organ. The described symptoms after treatment of thyroid disease most often disappear without additional interventions within 2 weeks from the moment of therapy.

Radioiodine therapy, after which approximately 10% of people develop inflammation of the salivary gland near the ear, can cause dry mouth, impaired swallowing of solid foods, and swelling in the ear area. In the form of prevention, intensive drinking is prescribed, chewing species tablets, sour candies.

The technique negatively affects the gastrointestinal tract, there are cases of the development of a radiation variety of gastritis and enteritis. The condition after radioiodine therapy may be such that a person feels pain in the abdomen, feels sick, and his appetite worsens. But such symptoms are usually minimal and go away on their own in less than a week. Some countries use an encapsulated radioactive preparation, which makes it possible to significantly reduce negative impacts on the gastric mucosa.

Individual cases suggest that high doses of iodine lead to inhibition of hematopoietic functions. bone marrow. There is a decrease in erythrocytes, platelets and leukocytes, but also given state goes away in a couple of months, one has only to follow the requirements of the attending physician in terms of lifestyle and the need to take additional pharmaceuticals to alleviate unpleasant symptoms following treatment.

Long-term consequences

For many years of using Iodine I-131, there were no confirmed facts of carcinogenic diseases as a result of therapy. Research suggests that radioiodine is absorbed by cells that have special receptors on their surface that are sensitive to it. Treatment with radioactive iodine is safe, the impact on other tissues and cells is minimal, which makes it possible to expand the boundaries of the use of the method.

The consequences of the mutagenic and teratogenic nature of the use of therapy remain a topical issue. Long-term studies do not support mutagenic effects. Short half-life, no accumulation, ability to preserve genetic material, fast recovery reproductive functionality is possible already one year after treatment.

Where is radioiodine therapy treated in Russia?

Radioactive treatment in Russia is carried out in many clinics:

RNTsRR "Russian science Center radiology";
Arkhangelsk "Northern Clinical Center Semashko";
Kazan "Center nuclear medicine»;
Obninsk Scientific Center Tsyba;
Krasnodar "Center for Nuclear Medicine of the Siberian Center of the FMBA".

How much does the treatment cost?

Having a compulsory medical insurance policy, persons in need of therapy can count on receiving a free type of quota. The first thing to do is contact one of medical institutions to find out if they can be treated. Specialists will give an answer about the possibility of treatment and the appropriateness of the quota. Practice shows that the chances of getting a quota at the beginning of the year are much greater than at the end.

Paid treatment will be faster, you will not have to wait and find out about the possibility of obtaining a quota. One has only to choose a clinic for treatment and start therapy.

The cost of treatment will depend on the level of the medical institution, the qualifications of its employees and, of course, on the dosage of the substance. On average, in paid clinic therapy can cost from 70 to 130 thousand. There are clinics where the price of the procedure is around 180 thousand rubles.

Information about the cost of the required therapy must be clarified during personal contact with the clinic, choosing the one that inspires confidence and peace of mind. After all, in the end, the effectiveness and success of further treatment will also depend on this.

What is ablation?

Radioactive iodine can destroy either the entire endocrine gland or part of it. This property is used to reduce the symptoms that accompany hyperthyroidism.

Ablation means destruction or erosive ulceration. Ablation with radioactive iodine is prescribed by a doctor, after an accurate determination of the dose of the microelement. Absorption is determined by scanning, the doctor monitors the activity of the endocrine gland and the amount of radioactive iodine that it captures. In addition, during the examination, the specialist “sees” diseased and healthy tissues.

When determining optimal dose iodine important criteria acts:

the size of the thyroid gland;
absorption test result.

Accordingly, the dose of radioactive iodine is increased depending on the size of the thyroid gland and the more it absorbs it, the more its amount is reduced.

How it works?

The isotope spontaneously decays to form several substances. One of them is a beta particle, which penetrates biological tissue with great speed and provokes the death of its cells. The therapeutic effect is achieved with the help of this type of radiation, which acts pointwise on tissues that accumulate iodine.

The penetration of gamma radiation into the human body and organs is recorded in gamma cameras, which reveal the centers of isotope accumulation. The places of luminescence recorded on the pictures indicate the location of the tumor.

Thyroid cells are arranged in an orderly manner, forming spherical cavities of A-cells (follicles). An intermediate substance is produced inside the organ, which is not a full-fledged hormone - thyroglobulin. This is a chain of amino acids in which there is tyrosine, capturing 2 iodine atoms each.

Stocks of finished thyroglobulin are stored in the follicle, as soon as the body feels the need for hormones of the endocrine gland, they immediately go into the lumen of the vessels.

To start therapy, you need to take a pill and a large amount of water to speed up the passage of radioactive iodine through the body. You may need to stay in the hospital in a special unit for up to several days.

The doctor will explain in detail to the patient the rules of behavior in order to reduce the effects of radiation on the people around.

Who is being treated

Patients included in the list are:

with diagnosed diffuse toxic goiter;

The popularity of the method provides it high efficiency. Less than half of patients with thyrotoxicosis receive adequate assistance when taking tablets. Treatment of the thyroid gland with radioactive iodine is an excellent alternative to radical treatment.

Principle of therapy

Before starting the process, the patient will have to go through the following steps:

Collection of analyzes and research of the thyroid gland.
The approximate date of radioiodine therapy is calculated and antithyroid drugs are canceled 2 weeks in advance.

The effectiveness of treatment during the initial session reaches 93%, with re-treatment 100%.

The doctor will prepare the patient in advance and explain what awaits him. On the first day, vomiting and nausea are possible. Pain and swelling appear in places of accumulation of radioactive iodine.

Very often, the salivary glands are the first to react, a person feels dryness of the mucous membranes of the mouth and a violation of taste. A few drops of lemon on the tongue, a lollipop or chewing gum helps to correct the situation.

Short term side effects include:

neck sensitivity;
swelling;
swelling and soreness of the salivary glands;
headache;
lack of appetite.

Goiter

With a toxic form of goiter (nodular or diffuse), hormones are present in excess, which leads to thyrotoxicosis. With diffuse damage to the endocrine gland, hormones are produced by the entire tissue of the organ, with nodular goiter - the formed nodes.

The goal is when radioactive iodine is used - the treatment of the thyroid gland, by exposing its areas to radiation from the isotope. Gradually, it is possible to "curb" the excess production of hormones and form a state.

Treatment of diffuse toxic goiter with radioactive iodine will lead to a decrease in hydration eyeball. It's an obstacle to wear contact lenses, so for a few days they will have to be abandoned.

After therapy, the patient needs to consume large amounts of water in order to quickly flush radioactive iodine from the body.
When visiting the toilet, hygiene rules should be followed as much as possible so that urine with isotope residues does not get anywhere except for the toilet drain.
Hands are washed with detergent and dried with disposable towels.
Be sure to change underwear frequently.
Take a shower at least 2 times a day to wash off sweat well.
The clothes of a person who has taken radioactive iodine therapy are washed separately.
The patient is required to observe the safety of other people, in connection with which: for a long time nearby (closer than 1 meter), avoid public crowded places, exclude sexual contact within 3 weeks.

The half-life of radioactive iodine lasts 8 days, during this period of time the cells of the thyroid gland are destroyed.

Cancer disease

A cancerous tumor is a mutated normal cell. As soon as at least one cell acquires the ability to divide at a high rate, they talk about the formation of oncology. Interestingly, even cancer-affected cells are capable of producing thyroglobulin, but at much lower concentrations.

The thyroid gland in your body absorbs almost all of the iodine that enters the body. When a person takes radioactive iodine in the form of capsules or liquid form, it concentrates in her cells. The radiation can destroy the gland itself or its cancer cells, including metastases.

Treating thyroid cancer with radioactive iodine is justified by the small effect on the rest of your body's organs. The dose of radiation used is much stronger than when scanning.

The procedure is effective when it is necessary to destroy thyroid tissue that is left after surgery after thyroid cancer treatment, if affected. The lymph nodes and other parts of the body. Radioactive thyroid treatment improves the survival of patients with papillary and follicular cancer. This is standard practice in such cases.

Although the benefit of radioactive therapy iodine is considered less obvious in patients with mild thyroid cancer. Surgical removal of the entire organ is considered more effective.

For effective treatment thyroid cancer, the patient must have high level thyroid-stimulating hormone in the blood. It stimulates absorption cancer cells and cells of the organ of radioactive iodine.

When removing the endocrine gland, there is a way to raise the level of TSH - refuse to take pills for several weeks. Low level hormones will cause the pituitary gland to activate the release of TSH. The condition is temporary, it is artificially induced hypothyroidism.

The patient should be warned about the occurrence of symptoms:

fatigue;
depression;
weight gain;
constipation
muscle pain;
decrease in concentration.

As an option, to increase TSH, thyrotropin is used in injections before radioactive iodine therapy. The patient is advised to refrain from eating foods containing iodine for 2 weeks.

Risks and side effects

Patients taking therapy should be warned about the consequences of:

Men who receive large total doses of radioactive iodine will have a reduced active sperm count. Very rarely, cases of development of subsequent infertility are recorded, which can last up to 2 years.
Women after therapy should abstain from pregnancy for 1 year and be prepared to violate menstrual cycle, as radioiodine treatment affects the ovaries. Accordingly, breastfeeding should be excluded.
Everyone who has undergone isotope therapy has increased risk development of leukemia in the future.

After treatment with radioactive iodine, the patient needs regular medical supervision throughout life. Radioiodine therapy has undeniable advantages over another radical solution - surgery.

The price of the procedure in different clinics varies slightly. An instruction has been developed that allows you to take into account all the requirements for safety and efficiency.

Radioiodine treatment allows you to quickly and painlessly eliminate the cause of thyroid disease. This is a modern way to regain lost good health with minimal risk to health.