Procedure for radioactive iodine treatment. Complex treatment of the thyroid gland with radioactive iodine. Advantages of modern non-surgical technique

You should know that even after a successful operation, a small part of the thyroid gland remains. Radioactive iodine treatment is used to destroy any remaining tissue or tumor cells.

The thyroid gland is the only organ in our body that absorbs and retains iodine. This property is used when the thyroid gland is treated with radioactive iodine. Read more about the principles of therapy, risks and consequences for the patient in the material.

Radioactive iodine (synonyms l131, radioiodine, iodine-131) is one of the isotopes of simple iodine (I126).

It has the ability to decay (spontaneously), in which a fast electron, gamma radiation, quantum and xenon are formed:

1. beta particle(fast electron) can reach very high speed. It is capable of penetrating and destroying biological tissues with a radius of 0.6-2 mm in the isotope accumulation zone. This explains the medicinal properties of I131 in thyroid cancer, diffuse toxic goiter (with these diseases, patients are often prescribed radioiodine therapy of the thyroid gland).
2. Gamma radiation can easily penetrate the human body. It does not have a therapeutic effect, but it has a diagnostic significance: with the help of special gamma cameras, it is possible to fix areas of increased accumulation of iodine-131. This allows you to evaluate the functional activity of the thyroid gland or determine the presence of metastases in a malignant lesion of the organ.

Thyroid scintigraphy

Consider how to check the thyroid gland with iodine, and what the patient needs to know about the features of the study. Scintigraphy, or radioisotope scanning of the thyroid gland, is a method of functional study of the functioning of an organ, based on its ability to absorb radioactive iodine molecules.

With the help of scintigraphy, you can evaluate:

• anatomical structure and location of the organ;
• the size of the thyroid gland;
• diffuse or focal changes in the organ associated with a violation of its functional activity;
• the presence of "cold" and "hot" nodes in the thyroid gland.

Note! In addition to the I131 isotope, iodine-123 can also be used to diagnose thyroid problems (it is preferred if the organ is then planned to be treated with radioactive iodine) or technetium Tc99.

Indications for the procedure

Most often, a radioisotope study of the thyroid gland is prescribed for:

• an increase in the size of the abnormally located thyroid gland;
• retrosternal goiter;
• thyroid nodes diagnosed on ultrasound (to determine their functional activity);
• thyrotoxicosis for differential diagnosis of the type of disease;
• well-differentiated thyroid cancer to detect distant metastases.

Also, according to the doctor's indications, the procedure is carried out to control the treatment of thyroid diseases, evaluate the results of the operation, and conduct medical examinations of patients observed for thyroid cancer.

Preparation for scintigraphy: what you need to know before the study

The instruction for the procedure does not imply any special preparation for it.

However, doctors warn of the importance of following two simple rules:

• if the patient is taking iodine preparations, they should be abandoned a month before the study;
• for 3 weeks, any diagnostic studies requiring intravenous administration of a radiopaque substance are excluded.

How is a radioisotope scan performed?

The procedure is painless, takes 15-25 minutes and is carried out in several stages:

1. Oral (by swallowing gelatin capsules) or intravenous administration of a radiopharmaceutical containing microdoses of I123, I131, or Tc99.
2. Distribution of radioiodine isotopes with blood flow throughout the body and their accumulation mainly in the tissues of the thyroid gland.
3. The patient is placed in a gamma chamber, in which the radiation force is read by the cells, and radioactive iodine is accumulated.
4. Transferring the received information to a computer, processing it and issuing the finished result.

It's important to know. The cost of this study largely depends on the clinic in which it is performed. The average price of scintigraphy in private research centers is 3000 rubles.

Evaluation of the results

Normally, radioactive iodine isotopes evenly accumulate in the tissues of the thyroid gland, and on the scan, the organ looks like two ovals with clear contours. Signs of pathology that can be diagnosed during the study are presented in the table below.

Table: Signs of thyroid pathology during radioisotope scanning:

Note! Radioisotope scanning is not a reliable method for diagnosing a malignant neoplasm of the thyroid gland. A doctor can make a diagnosis of cancer only after performing a fine-needle biopsy and subsequent morphological examination of the obtained biomaterial.

Just about complex

Radioactive iodine is used to treat hyperthyroidism, it gradually reduces the volume of the thyroid gland until it is completely destroyed. The treatment method is much safer than it seems and, in fact, it is more reliable, has a stable result, in contrast to taking antithyroid drugs.

During the operation, the surgeon carefully removes the gland tissue. The difficulty lies in the very close location of the nerve of the vocal cords and, it is necessary to act with utmost care in order to prevent damage. The operation is complicated by an even greater number of blood vessels in the tissue of the endocrine gland.

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 the optimal dose of iodine, important criteria are:

• 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 endocrine gland hormones, they immediately exit 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 ensures its 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 repeated therapy 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 of the eyeball. This is an obstacle to wearing contact lenses, so they will have to be abandoned for several days.

• 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 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: do not stay close for a long time (closer than 1 meter), avoid public places, exclude sexual contacts for 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 capsule 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 the thyroid tissue that is left after surgery after thyroid cancer treatment, if the lymph nodes and other parts of the body are affected. Radioactive thyroid treatment improves survival in patients with papillary and follicular cancer. This is standard practice in such cases.

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

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

When removing the endocrine gland, there is a way to raise the level of TSH - refuse to take pills for several weeks. Low hormone levels 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 for menstrual irregularities, since radioiodine treatment affects the ovaries. Accordingly, breastfeeding should be excluded.
• Everyone who has received isotope therapy has an increased risk of developing leukemia in the future.

After treatment with radioactive iodine, the patient needs regular medical supervision throughout his 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.

Iodine is a chemical that was discovered back in 1811 by the French chemist Bernard Courtois when mixing seaweed ash and sulfuric acid. A couple of years later, his compatriot, the chemist Gay-Lussac, studied the resulting substance in more detail and proposed the name "iodine". Translated from Greek, "iodine" means "violet", in connection with the appearance of a purple color when it is burned.

Iodine and the thyroid gland

The main function of the thyroid gland is the production of the hormone thyroxine. Thyroxine is a very important hormone in

our body, participating in all metabolic processes, supporting the work of muscles, the brain and all internal organs. Thyroxine can be compared to fuel for the body, like gasoline for a car. Thyroxine is formed in the cells of the thyroid gland with the participation of iodine and the amino acid tyrosine. There are four iodine atoms in the thyroxine molecule. The peculiarity of thyroid cells is that they have the ability to capture iodine from the bloodstream and transfer it into the follicle (structural unit of the thyroid gland). Already inside the follicle, under the action of special enzymes, thyroxine is formed from the amino acid tyrosine and four iodine atoms. Treatment with radioactive iodine is based on the ability of thyroid cells to capture iodine.

What is radioactive iodine

Every chemical element has one or more isotopes whose nuclei are unstable and when radioactive decay produces electromagnetic radiation, which can be alpha, beta or gamma. Isotopes are called chemical elements that have the same number of protons, but a different number of neutrons, while isotopes differ from each other in physical properties. There are 37 known isotopes of iodine. I-127 is stable, and the most commonly used isotopes of radioactive iodine in medicine are I-131, I-123, I-124. Iodine is usually denoted by the letter I. When designating an isotope, next to the letter I indicate the number of protons and neutrons in its atom. It is important to note that the number of protons in an iodine atom is constant - there are always 53 of them. If we are talking about the isotope of radioactive iodine 131 (I-131), this means that its atom contains 53 protons and 78 neutrons (their sum is 131, which is indicated in the numerical part of the isotope designation). If iodine is 123, then its atom also has 53 protons, but already 70 neutrons, etc. It is the number of neutrons that determines the properties of the isotope and, as a result, various diagnostic and therapeutic purposes. An important characteristic of radioactive iodine is its half-life. So, for example, for I-131 this period is 8 days, for I-124 it is 4 days, and for I-123 it is 13 hours. The half-life is the period during which the activity of iodine falls by half. The decay of radioactive iodine (I-131) produces xenon, beta particles and gamma radiation.

The principle of action of radioactive iodine in the treatment of thyroid cancer

Radioactive iodine treatment should only be given to patients who have had their thyroid completely removed.

If part or half of the thyroid gland is removed, radioactive iodine treatment is pointless. Thyroid cells have the ability to capture iodine from the blood. It is important to note that thyroid cancer cells (papillary, follicular) are less active, but can also capture iodine. Tumor cells, when exposed to radioactive iodine, die under the influence of beta radiation. The penetrating power of beta radiation is from 0.6 to 2 mm, which makes it possible to destroy cells in which iodine has accumulated, but there is no damage to surrounding tissues. One of the objectives of radioactive iodine treatment is the destruction of residual thyroid tissue, which is present even after a perfectly performed operation. It is not uncommon for an endocrinologist surgeon to deliberately leave a small amount of healthy thyroid tissue in both the recurrent laryngeal nerve area (to preserve the voice) and the parathyroid glands (for their normal functioning). Thus, radioactive iodine destroys not only possible cancer metastases, but also the residual tissue of the thyroid gland, which allows more accurate control of thyroglobulin levels in the postoperative period. Gamma radiation, which is formed during the decay of radioactive iodine, freely penetrates through all tissues of the body and can be recorded using a gamma camera. Gamma radiation does not carry a therapeutic effect, but is used for diagnosis. The result of the scan indicates in which part of the body radioactive iodine has accumulated, which may indicate the presence of thyroid cancer metastases. As a rule, when scanning the whole body after radioiodine therapy, the accumulation of the drug is detected on the anterior surface, in the place where the thyroid gland was. Also, the accumulation of iodine occurs in the salivary glands, along the digestive tract and in the bladder. Sometimes iodine can accumulate in the mammary glands, which have small amounts of iodine receptors.

When scanning the whole body, it is important to check for distant metastases. Most often, metastases are detected in the lymph nodes of the neck and mediastinum, in the lungs and even bones.

Indications for radioactive iodine treatment

According to international and Russian clinical guidelines, there are three risk groups among patients with thyroid cancer. Depending on the risk group, the endocrinologist surgeon determines the need for radioactive iodine treatment. The risk group is determined by the probability of the presence of distant metastases and the progression of the tumor process.

Low risk group.

Patients with a tumor that does not exceed 1–2 cm in size and does not extend beyond the thyroid gland can be classified as low-risk. There are no metastases in the lymph nodes of the neck and other organs. Low-risk patients are not prescribed radioactive iodine therapy.

Medium risk group.

The medium-risk group includes patients with a thyroid tumor larger than 2-3 cm in diameter, with germination of the gland capsule and unfavorable histological variants. Patients in this group are usually prescribed radioactive iodine therapy. In this case, the dosage can be from 30 to 100 millicuries (mCi).

High risk group.

This group includes patients with aggressive growth of thyroid cancer, when there is germination in the surrounding tissues (muscles, blood vessels, trachea), lymph nodes of the neck and there are distant metastases. Patients in this group are required to be treated with radioactive iodine at a dose of 100 mCi or more.

Increasing TSH TSH is a thyroid-stimulating hormone that is produced by the pituitary gland and normally regulates the functioning of the thyroid gland. One of the important properties of TSH is to stimulate the growth of thyroid cells. It is known that TSH also stimulates the growth of thyroid tumor cells. It is important to note that thyroid cancer cells are less able to take up iodine than healthy thyroid cells. However, with a high level of TSH, thyroid tumor cells are better able to capture radioactive iodine, and therefore are better destroyed. Two methods are used to increase TSH levels: stopping L-thyroxine for four weeks or administering recombinant TSH (an artificially created preparation of human TSH).

Stop taking thyroxine

To increase the TSH level before treatment with radioactive iodine, patients stop taking thyroxine for a period of three to four weeks. In this case, the TSH level should become above 30 mU / l. In fact, the higher the TSH, the better the thyroid tumor cells will be destroyed. In addition to stimulating thyroid cancer cells, the abolition of thyroxine intake leads, so to speak, to "starvation" of tumor cells for iodine. After all, we must not forget that there are four iodine atoms in thyroxine, and when taking a pill, tumor cells take on some of this iodine. If within three to four weeks iodine does not enter the body, then the tumor cells, when radioactive iodine is harmful to them, begin to actively capture it. As it was written earlier, after radioactive iodine enters the cell, it is destroyed.

The main disadvantage of thyroxine withdrawal is the occurrence of hypothyroidism. Hypothyroidism is a lack of thyroid hormones that can be accompanied by various symptoms. It is important to note that the manifestation of hypothyroidism against the background of the withdrawal of thyroxin before the treatment with radioactive iodine manifests itself differently in all patients. There are patients who practically do not feel the withdrawal of thyroxin, at the same time, there are patients who already two weeks after the withdrawal of the drug complain of sudden weakness, apathy and swelling of the face or other manifestations of hypothyroidism.

Symptoms of hypothyroidism:

Leather: may be dry, pale, and cold to the touch.

Hair: become brittle and fall out.

Gastrointestinal tract: patients feel a decrease in appetite, taste, constipation may occur.

Respiratory system: some patients may experience diaphragmatic weakness and, as a result, breathing problems (shortness of breath, weakness of breathing).

Nervous system: memory impairment and decreased attention, the appearance of headaches, the development of depressive states is possible.

The cardiovascular system: the pulse becomes rare (bradycardia), mild arterial hypertension (increased blood pressure) may occur, and atherosclerosis may progress in some patients.

Hematopoietic system: mild anemia (a decrease in the level of hemoglobin in the blood), an increase in bleeding time with cuts and injuries is possible.

Muscular system: with hypothyroidism, patients feel weakness in the muscles, physical activity is difficult to tolerate. It is important to note that after the start of taking thyroxin, the symptoms that arose against the background of hypothyroidism disappear and do not reappear with the right dosage.

The use of recombinant TSH

Recombinant TSH is TSH in the form of a pharmacological preparation for intravenous administration, which was synthesized artificially. The use of recombinant TSH is the second way to increase the level of TSH in the patient's body before radioactive iodine treatment. Unfortunately, recombinant TSH is not registered in Russia and cannot be officially used to prepare for radioactive iodine treatment. The closest countries where you can officially get recombinant TSH are Ukraine, Estonia, Finland.

Diet low in iodine (iodine-free diet)

All patients are prescribed an iodine-free diet in preparation for radioactive iodine treatment. The idea of ​​an iodine-free diet is to avoid iodized salt and foods containing iodine from the daily diet as much as possible. The daily intake of iodine should be kept to a minimum, not exceeding 50 micrograms per day. The duration of the diet is one to three weeks before radioactive iodine therapy and one to two days after treatment.

What is the effect of "starvation" and why do I need an iodine-free diet

When recommending radioactive iodine treatment, the specialist doctor understands that the patient is at risk of having thyroid cancer metastases (in the lymph nodes of the neck, lungs, liver, bones). It is important not to forget that thyroid cancer cells have lost the properties of healthy cells, but in the vast majority they have not lost the ability to capture iodine.

Imagine a patient with thyroid cancer metastases, for example, to the lungs. The patient restricts himself in iodine intake for one to three weeks (an obligatory step in preparing for iodine treatment is the abolition of L-thyroxine), while the entire body receives less iodine. Most importantly, the thyroid cancer cells that reside in the lungs are also starving for iodine.

Preparing for Radioiodine Therapy

The day comes when you receive a dose of radioactive iodine, and the thyroid cancer cells “do not understand” whether they received radioactive iodine or ordinary. Against the background of prolonged “starvation”, they begin to capture radioactive iodine from the blood with greater force. The more actively cancer cells capture radioactive iodine, the more destructive it acts on them. Against the background of a properly maintained iodine-free diet and the abolition of thyroxin, the effectiveness of radioactive iodine treatment will be maximum.

Treatment with radioactive iodine

After the preparation - the abolition of L-thyroxine (or the introduction of recombinant TSH) and an iodine-free diet - determine the required dose of iodine and proceed directly to treatment. The dosage of radioactive iodine is determined by radiologists. There are several commonly used doses of radioactive iodine: 30, 100 and 150 mCi (mCi). The choice of one or another dosage is carried out depending on the prevalence and aggressiveness of thyroid cancer. For example, if the tumor has grown only in the capsule of the thyroid gland, the dose of iodine will be less than if the cancer has spread to the lymph nodes of the neck, lungs, or bones. After selecting the dose of radioactive iodine under the supervision of specialists, the patient takes the drug. Radioactive iodine comes in two forms: a capsule or a liquid. The therapeutic and diagnostic effect of the capsule or liquid form is not fundamentally different.

It is important to note that the main routes of excretion of radioactive iodine from the human body are the urinary system, gastrointestinal tract, salivary and sweat glands. The patient will be given detailed advice on nutrition, fluid intake and personal hygiene while in the clinic and upon returning home. After receiving radioactive iodine, radiation is emitted from the patient, which can be dangerous to some extent for the people around. In this regard, all patients who have received a dose of radioactive iodine are explained in detail how to behave with others. The main recommendation is to avoid contact with children and pregnant women for at least a week after receiving a dose of radioactive iodine. Very often I hear from patients that the period of isolation from other people after treatment with radioactive iodine should reach a month or more. This information is not true. I will cite data prepared in 2011 by the American Thyroid Association (ATA) in conjunction with the International Commission on Radiation Protection (ICRP). The maximum isolation period (being in the same bed with pregnant women, newborns or children) of 21 days applies to patients who received a dose of radioactive iodine equal to 200 mCi. At the same time, the periods of isolation in the most common situations that patients face when they are discharged from the clinic after treatment with radioactive iodine, such as going to work, talking with friends, walking in crowded places, do not exceed one day. Patients who follow these recommendations and the basics of personal hygiene are not dangerous to others and can absolutely calmly be in society and lead a normal life.

Regarding the timing of planning children after radioactive iodine treatment, there are the following recommendations: for men - after 2-3 months, for women - after 6-12 months. I advise all patients who have undergone radioactive iodine treatment to have documents from the clinic with them when crossing borders or checkpoints equipped with radiation detection devices for two to three months. During these periods, you, of course, are not dangerous to anyone, but modern devices can detect radiation from you and give a signal to the appropriate services about this. Most often, such situations occur at checkpoints at airports, so plan your time taking into account possible delays.

The effect of radioactive iodine on the body

It is important to understand that radioactive iodine is not a vitamin complex, and its appointment should be carried out strictly according to

indications, according to international and Russian clinical guidelines. Before the course of treatment with radioactive iodine, the patient should be familiar with the possible adverse effects that may occur immediately or some time after taking the radiopharmaceutical. The development of undesirable symptoms directly depends on the dosage of the received radioiodine. Patients can be divided into three groups, depending on the frequency and severity of side effects. The first group may include patients who have had a diagnostic scan with low doses of radioiodine. The second group, the largest, includes patients who underwent radioiodine therapy after surgery and received an iodine dose of 30 to 200 mCi. The third group of patients, fortunately not numerous, includes those who repeatedly received high doses of radioactive iodine.

In diagnostic scanning, the dose of radioactive iodine does not exceed 1–5 mCi, and in such cases, adverse effects are extremely rare. When conducting radioactive iodine treatment, depending on the type of cancer, spread beyond the thyroid gland and the size of the tumor, the dose can vary from 30 to 200 mCi. In such cases, side effects are possible, and their likelihood is higher, the higher the dose of radioactive iodine received. The most common adverse symptoms after receiving a therapeutic dose of radioactive iodine are as follows. Swelling and pain. In some patients, after receiving a dose of radioactive iodine, swelling occurs in the neck (in the area where the thyroid gland was). This phenomenon can be explained by the destruction of the residual tissue of the thyroid gland. At the same time, the surrounding tissues react (muscles, lymph nodes, fatty tissue), which are involved in the edema, increasing in size. The swelling usually goes away after a few days and does not require treatment. With severe discomfort, the patient can be prescribed anti-inflammatory drugs with a good therapeutic effect. Nausea and vomiting. Nausea and vomiting may occur hours or days after receiving a therapeutic dose of radioactive iodine. These symptoms may be more active in patients with chronic diseases of the gastrointestinal tract. As a rule, in a clinic where radioactive iodine treatment is carried out, they talk about the correct water regime and, if necessary, prescribe drugs that protect the stomach and intestines (antacids).

Inflammation of the salivary glands (sialadenitis).

A person has three paired (right and left) salivary glands. The largest is the parotid salivary gland, which is located on the lateral surface of the face - just below and anterior to the ear. The other two are the submandibular and sublingual glands. The resulting therapeutic dose of radioactive iodine partially accumulates in the salivary glands and, as a result, causes their inflammation. The parotid salivary gland is most sensitive to iodine. Sialoadenitis occurs in almost 30% of patients treated with radioactive iodine. The unpleasant thing is that sialoadenitis can occur both a day and a few months after receiving radioactive iodine. A manifestation of sialoadenitis is pain and swelling in the area of ​​the salivary gland, fever, and a decrease in the amount of saliva. The pain usually gets worse with eating.

Treatment of sialadenitis is not an easy task. First of all, it is important to inform your doctor about the occurrence of problems with the salivary glands. Your doctor will definitely recommend who to contact for help.

Depending on the situation, different regimens for the treatment of sialadenitis can be used. The main recommendations when it occurs are as follows:

1. The use of sour sweets, chewing gums, that is, means that enhance salivation. This will lead to a more active removal of radioactive iodine from the salivary glands, which should reduce the likelihood of their further inflammation.

2. Consumption of a large amount of liquid. When a large amount of liquid is received, more saliva will be produced, with the current of which radioactive iodine will be better excreted.

3. The use of anti-inflammatory drugs. Anti-inflammatory drugs reduce swelling and thereby reduce pain in the salivary gland area.

4. Massage of the parotid salivary gland.

The technique of massaging the parotid salivary gland is as follows: with the fingertips, the first movement is made from the bottom up from the angle of the jaw, when the palm of the lower jaw is touched, the second movement of the fingers is made towards the nose. This simple manipulation improves the outflow of saliva from the gland.

It is very important not to self-medicate, but to seek help from a specialist as soon as possible. As a rule, patients get a consultation with a maxillofacial surgeon, who, after examination and the necessary research, determines the treatment tactics. Dry mouth syndrome (xerostomia). Occurrence of dry mouth after radioactive treatment Massage of the parotid salivary gland with iodine is associated with a decrease in saliva production. This symptom may occur after a week or several months from the day of therapy. Then the inflammation in the salivary glands usually disappears and salivation is restored.

Change in taste. At least a third of patients feel a change in taste after treatment with radioactive iodine. For them, food may have a metallic taste or no taste at all. As a rule, changes in taste sensations disappear after a couple of weeks without special treatment.

Conjunctivitis, inflammation of the lacrimal jellyPS.

According to some reports, the occurrence of inflammation of the conjunctiva (thin smooth tissue that covers the outside of the eye) occurs only in 1-5% of patients treated with radioactive iodine. Inflammation of the lacrimal gland is also rare. If you experience any discomfort in the eye area, you should seek the advice of an ophthalmologist as soon as possible.

Hypoparathyroidism.

The parathyroid glands are responsible for the production of parathyroid hormone, which in turn controls calcium metabolism. Extremely rarely, but after receiving radioactive iodine, a decrease in the function of the parathyroid glands (hypoparathyroidism) may occur. The main symptoms of hypoparathyroidism are tingling on the face, goosebumps in the face and fingers. It is important not to confuse these symptoms with an exacerbation of cervical osteochondrosis. At the slightest doubt, you need to check the level of parathyroid hormone and ionized calcium. If the indicators are normal, then the patient does not have hypoparathyroidism.

Hair loss (alopecia).

Unlike chemotherapy and other cancer treatments, radioactive iodine does not cause hair loss. The most common hair problem is due to low thyroid hormone levels in preparation for radioactive iodine treatment. With the resumption of taking L-thyroxine, complaints of hair loss disappear.

Influence on reproductive functions.

There is still no scientific data on the negative impact of radioactive iodine on the conception or bearing of children. In women after radioiodine therapy, the risk of infertility, problems with bearing or the development of congenital anomalies in children is not higher than the average in the population. It is recommended to plan children one year after radioiodine therapy.

If repeated high doses of radioiodine are expected, then women may be advised to cryopreserve their own eggs, and men - cryopreservation of sperm.

Occurrence of other malignant tumors.

One of the first questions patients ask when discussing radioactive iodine treatment for thyroid cancer is, "Does radioactive iodine cause cancer in other organs?" If the total dose of radioactive iodine reaches 600 mCi or more, the patient is slightly more likely to develop leukemia (a tumor of the hematopoietic system originating from bone marrow cells) compared to the average values ​​in the population. A group of foreign scientists monitored more than 500 patients in order to identify the effect of the combined action of radioactive iodine and external beam radiation therapy. As a result, the development of leukemia in the study group was detected only in three patients, which amounted to 0.5%. It is important to note that at present there is no convincing scientific evidence that radioactive iodine treatment increases the risk of developing malignant tumors of any other organs.

Consultation with a specialist in radioactive iodine treatment

The method of using radioiodine therapy dates back to 1934. The US endocrinologists were the first to use this method for the treatment of the thyroid gland. Only seven years later, radioactive iodine began to be used in other countries.

Patients treated in America or Israel receive outpatient care because it is cheaper. In Russia and Europe, patients are treated in clinics.

Radioactive iodine is used when thyroid treatment is necessary to prevent further development of the disease.

The main goal of this method of thyroid therapy with radioactive iodine is to destroy thyrocytes and atypical cells of malignant neoplasms of the organ. During this procedure, radiation exposure of the whole organism is excluded. The isotope I-131, which is created artificially, is used. Take it once or as a course to reduce the hyperactivity of the gland.

This method is used when diseases associated with thyroid hyperactivity are detected:

1. Hyperthyroidism is a phenomenon in which small, benign nodules form.
2. Thyrotoxicosis is a complication of hyperthyroidism.
3. Diffuse toxic goiter.
4. Treatment of thyroid cancer with radioiodine therapy is the most effective. With cancerous lesions, the foci are completely removed, but after surgery, radioiodine therapy is recommended. The fact is that even after the removal of foci, the appearance of new ones, both benign and malignant, is possible.

The isotope I-131 seeps into the cells of the thyroid gland, which have increased activity, destroys diseased cells. Only the thyroid gland is affected, and during this period the functions of the thyroid gland are inhibited. Therapy can be carried out by a one-time method or carried out in a certain course. The decision is made by the attending physician based on the condition of the organ. The isotope does not affect other organs during the procedure.

The injected I-131 isotope is immediately captured by the active cells of the organ and begins to destroy them. Since the isotope is collected exclusively by thyroid cells, destruction occurs only in this organ.

1. After the surgical intervention.
2. When the patient's body does not perceive well or does not react at all to drugs.
3. Patients over 60 years of age.
4. If a relapse occurs, for example, in the treatment of cancer or diffuse goiter.
5. Patients who, for some reason, cannot be operated on and drug treatment does not work.
6. Patients with serious cardiovascular problems.

Radioiodine therapy gives a good effect only if highly differentiated cancer is detected: follicular and papillary. For other forms, other methods of therapy are selected. Before prescribing radioactive iodine treatment, the patient is given a complete examination. Indicators of the state of the thyroid gland are needed to determine the required concentration of the isotope.

The goal pursued in preparing the patient for radioiodine therapy is to increase the amount of thyroid-stimulating hormone, which performs a controlling function in the normalization of the thyroid organ. The higher the TSH levels before radioiodine therapy, the more effective the treatment will be, because the activity of cancer cells contributes to their most rapid destruction.

An increased level of TSH in the blood activates the thyroid gland to synthesize its own hormones and activates the organ to absorb the iodine-containing component. The same hormone stimulates the growth of cancer cells. When there are high levels of TSH, the absorption process increases, but their destruction process also increases accordingly.

There are two ways to achieve an increase in thyroid-stimulating hormone:

1. Introduce an artificial drug - recombinant TSH. This drug has not been tested in Russia. It can only be used where it has already been officially registered: Finland, Estonia, Ukraine.
2. Stop taking thyroxine 3-4 weeks before the procedure. The body stops access to iodine-containing products.

The preparatory process itself can last a month, and sometimes more.

When a decision is made to use radioactive iodine in the treatment of thyroid gland, the patient is offered not to take medications that are hormone substitutes before the start of the course, approximately 2 to 4 weeks before the start of the course.

Before this method of therapy, even after removal of the thyroid gland, thyrotoxin is not prescribed in order to conduct radioiodine therapy. Cancellation of thyrotoxin creates conditions for cancer cells to absorb radioactive iodine.

Therefore, when I-131 begins to enter the body, they begin to actively capture it. Cancer-damaged cells do not understand what kind of iodine they absorb. Therefore, the more active they are, the faster they will die.

Patients are advised to follow an iodine-free diet. In fact, this is a vegetarian diet. The purpose of the diet: conditions must be created for maximum absorption of radioiodine by thyroid cells. The preparatory process for radioiodine therapy necessarily includes the use of a low-iodine diet.

For this period, it is required to exclude from use:

• seafood;
• seaweed, including cabbage;
• any milk products;
• products using egg yolks;
• soy products;
• legumes dyed red;
• some fruits: persimmons, apples, grapes;
• sea ​​fish;
• Hercules porridge.

Do not use food supplement E127. It is added to some canned meats, raw smoked sausages, canned fruits such as strawberries and cherries. It is found in sweets that have a pink color. It is not necessary during this period to consume a lot of greens grown on iodine-enriched soils.

This restriction is temporary, you only need to observe it for the recommended 3-4 weeks.

During this period, there should be no additional health problems. As soon as the period is over, the doctor will allow the patient to switch to the usual diet.

While following the diet, you should follow the rules:

1. The daily diet should provide physical activity of a person.
2. The menu should include only permitted products.
3. The number of products is limited, but not minimal, should not provoke a deterioration in health.
4. When following a diet, do not use semi-finished products.
5. Use regular salt.
6. Noodles, bread are best cooked at home without the use of yolks and milk. Egg whites can be consumed.

An iodine-free diet helps prepare the body for taking the drug. However, it was noticed that the process of recovery of the body after therapy is faster. In addition, dieting allows the body to get unloaded. It is easily transferred.

Treatment with radioactive iodine may consist of a single capsule consumption, but sometimes a course of administration is prescribed. The preparation may be in the form of a capsule or be in liquid form. Upon completion of the diagnostic process, a capsule of the desired dose is created. It is made individually and the entire manufacturing process takes about a week.

The patient takes the capsule and can go home. However, it is better that the patient is under the supervision of specialists for five days. On the day of taking the isotope, you should refrain from eating two hours before taking it, and also after taking it. You can only drink liquid in large quantities. The liquid will facilitate the removal of the isotope from the body.

After taking the capsule, the patient is a weak source of radiation for several days, which should not be exposed to people around him. In the room at first, where the patient is located, who has taken the capsule, it is not allowed to enter children, pregnant women.

Bedding is changed every day. It also requires a thorough cleaning of the toilet after each use. The fact is that sweat and saliva, as well as other body secretions, will initially be a source of radiation in small quantities.

The effectiveness of this method of therapy is quite high: in 98% of patients, improvements are observed.

However, the consequences of therapy may have side effects that are short-term:

• tingling on the tongue;
• discomfort of the neck;
• feeling of dryness in the mouth;
• sore throat;
• haunted by nausea and vomiting;
• taste sensations may change;
• puffiness.

Many patients are terrified of this method of treatment, arguing their fear of possible exposure. This is completely unsubstantiated. Radioactive iodine treatment is a unique alternative to surgery. Subject to all the recommendations and requirements of the doctor, the procedure brings its positive results.

Radioactive iodine is an alternative method that is used when the organ is completely removed. This therapy is effective in differentiated forms of cancer and other diseases of this organ. In some cases, this method is the only chance for a patient to have a favorable outcome. The expediency of the procedure is determined by a qualified specialist based on the established diagnosis.

Radioactive iodine 131 - what is it?

Iodine is an important element in the human body, which has the ability to accumulate and be retained by the cells of the thyroid gland. This allows the body to use the component for the production of thyroid hormones necessary for the normal functioning of vital organs and body systems.

Radioactive iodine 131 is a synthetically synthesized isotope of iodine. The substance has no taste, color or smell. In medicine, this component is used to treat various diseases of the thyroid gland. The therapeutic effect is based on the fact that when it enters the body, radioactive iodine self-disintegrates within 8 days and forms xenon, as well as beta and gamma radiation. This feature of the substance is the main goal of treatment, as it contributes to the destruction of tumor cells.

90% of the therapeutic effect is achieved due to beta particles, which have a high speed of movement and a small mileage in tissues (2 mm). Their radioactivity contributes to the destruction of residual thyroid cells and tumors that have spread beyond it.

Gamma particles do not have a therapeutic effect, but they are characterized by high penetrating power. Due to this, with the help of special gamma cameras, it is possible to detect the presence and location of metastases, in which the accumulation of radioactive iodine is recorded.

The essence of the method of radioiodine therapy

This method of treatment is used for patients who underwent surgical removal of the thyroid gland. The procedure is used after 4 weeks after the operation.

When radioactive iodine is introduced into the body, the residual cells of the organ and tumors capture and accumulate it. Due to this, their destruction occurs, which allows you to stop the development of the disease. As a result, the function of the thyroid gland is completely inhibited. The effect of the isotope does not extend to adjacent tissues.

The required dosage of the substance is selected by an experienced specialist based on the form and stage of the pathological process.

Indications for carrying out

Radioiodine therapy of the thyroid gland is prescribed only when its effectiveness is fully justified.

The main indications for the procedure:

• hyperthyroidism against the background of increased activity of the thyroid gland;
• thyrotoxicosis;
• nodular goiter;
• papillary, follicular, anaplastic type of cancer;
• the presence of metastases.

Specialists divide all patients suffering from thyroid cancer into three main risk groups. Each of them means the degree of probability of the recurrence of the disease, as well as the appearance of metastases.

Based on these data, the required dosage of radioactive iodine in millicuries is determined, as well as the feasibility of the procedure.

1. Low risk group. The size of the tumor does not exceed 1-2 cm, so the neoplasm does not extend beyond the thyroid gland, and there are no metastases. Radioiodine therapy is not prescribed in this case.
2. Medium risk group. The tumor is over 3 cm in diameter, so it has grown into the capsule. The dosage of radioactive iodine is 30-100 mCi.
3. High risk group. The size of the tumor rapidly increases, which leads to its germination in neighboring tissues, and distant metastases are also present. The amount of radioactive iodine is prescribed from 100 mCi.

Contraindications

According to reviews, the treatment of "thyroid gland" with radioactive iodine is very effective, but this therapy is not useful for everyone.

Main contraindications:

• pregnancy;
• large or multinodular goiter;
• individual intolerance to iodine;
• lactation;
• thyroiditis after childbirth;
• psychiatric illnesses;
• hepatic, renal failure;
• severe form of decompensated diabetes mellitus;
• hypoplastic, aplastic anemia;
• gastric ulcer, duodenal ulcer in the period of exacerbation.

Radioiodine therapy is allowed only for patients who have reached the age of 18.

Benefits of radioiodine therapy

Judging by the reviews, the treatment of "thyroid gland" with radioactive iodine has several advantages. This is confirmed by experts who claim that with the help of this method it is possible to act pointwise on the thyroid gland and neoplasms present in it, without involving adjacent tissues in the process.

The main advantages of radioiodine therapy:

• no need for anesthesia;
• low recurrence rate;
• there are no scars after the procedure;
• the minimum number of contraindications;
• short rehabilitation period.

Preparation for the procedure

In order for the therapy to be as effective as possible, it is necessary to prepare the patient in advance for the use of the isotope. The main role in the effectiveness of treatment is assigned to thyroid-stimulating hormone (TSH), which is synthesized by the pituitary gland. Since it is he who is responsible for the accumulation of iodine by the thyroid gland.

Malignant cells are less absorbent, so it is necessary to create an increased level of TSH in the body in order to improve the uptake of radioactive iodine by the tumor.

There are two main ways to increase the level of thyroid-stimulating hormone to the required level.

1. Stopping replacement therapy. Medications should be stopped 3-6 weeks before radioiodine therapy. In this case, TSH reaches 30 and above, which is well above the level of the normal range. The disadvantage of this method is the appearance of hypothyroidism, accompanied by unpleasant symptoms.
2. Injections of "Thyrogen" (a recombinant of human TSH). The introduction of the drug is carried out a few days before the use of the isotope, which can significantly accelerate the increase in the level of the hormone.

Both methods of increasing TSH are effective, but which one to choose is determined by the doctor, depending on the individual characteristics of the patient.

In addition, it is necessary to follow some general recommendations for preparing the body for the effects of an isotrope.

1. Exclude exposure to iodine from the outside. This means that you should not swim in salt water, breathe sea air, and lubricate wounds with iodine. All these requirements must be met for four days prior to the start of radioiodine therapy.
2. Stop taking vitamins, hormones and nutritional supplements 1 month before the procedure.
3. Women should be screened for pregnancy, as the isotope negatively affects the development of the fetus.
4. Stop taking medication for hyperthyroidism 7 days before the procedure.

Required Diet

Nutritional adjustment is also an important condition for preparing the patient for radioiodine therapy. The diet implies a significant reduction in the diet of foods containing iodine. This is a necessity to create a deficiency of this component in the body. As a result, this will lead to active absorption of radioactive iodine by tumor cells.

It is necessary to adhere to a diet 2 weeks before therapy and within 5-7 days after it.

Allowed products:

• fresh meat (no more than 140 g per day);
• fresh apples, oranges, lemons, grapefruits;
• pasta;
• egg whites.

It is also allowed to use unsalted nuts, vegetable oil, sugar, honey, fruit jam, tea, compote based on raisins, peanut butter.

Prohibited products during this period:

• any seafood;
• egg yolks;
• chocolate;
• dairy;
• iodized salt;
• soy and products based on it;
• sausage;
• all products that have an orange, brown and red tint;
• coffee;
• ice cream.

How is the treatment going?

Radiotherapy is carried out in a hospital setting. The patient needs to swallow a capsule or an aqueous solution of radioactive iodine and drink plenty of water (at least 400 ml).

After that, the patient is isolated in a separate room, since exposure from him is a danger to others. Therefore, initially it is necessary to take a minimum of things with you, since they are subsequently subject to disposal.

Within 2 hours after the procedure, the intake of solid food is prohibited, since during this period there is an active absorption of iodine by the thyroid gland and tumor cells.

At least once a day, radiation is measured, and until this indicator drops to a normal level, the patient will be isolated from others. On average, this period lasts from 3 to 7 days.

Side effects

The consequences of radioactive iodine treatment of the thyroid gland may be different. In each person, they are expressed differently depending on the age and volume of the injected isotrope.

The most likely side effects of thyroid radioiodine therapy are:

• nausea;
• vomit;
• general weakness;
• loss of appetite;
• swelling in the neck.

Radiotherapy in 30% of patients is accompanied by inflammation of the salivary glands. This unpleasant symptom appears 24 hours after the procedure and is often caused by the introduction of a large amount of isotrope against the background of residual thyroid tissue.

According to reviews, the treatment of "thyroid gland" with radioactive iodine in a third of patients causes a change in taste sensations. In this case, the food becomes tasteless or acquires a metallic taste. This symptom resolves on its own after 10-15 days.

The use of an isotrope can provoke an exacerbation of chronic diseases such as cystitis, pyelonephritis, gastritis. Symptomatic therapy is prescribed to eliminate unpleasant consequences.

So far, there is no substantiated evidence that radioiodine therapy has a negative impact on the conception and bearing of a child. But planning for children is recommended only a year after this procedure.

Recovery period

The duration of rehabilitation after radioiodine therapy of the thyroid gland is about 1 month. During this period, a person should adhere to the doctor's recommendations, which will help protect others from the possibility of exposure, as well as speed up the recovery of the patient.

1. It is necessary to increase water consumption to 1.5-2 liters per day, which will speed up the process of removing the isotope from the body.
2. It is necessary to take a shower at least 2 times a day.
3. Approaching others and pets should be no more than 1 m, it is forbidden to kiss and hug children.
4. Sleep alone and in a separate room.
5. Men should urinate while sitting.
6. After using the toilet, flush the tank twice with used toilet paper, and wash your hands thoroughly with soap and water.
7. All personal hygiene items should be kept in a plastic bag.
8. It is recommended to use separate dishes.
9. Bed linen and clothing should be washed daily.
10. If possible, limit contact with loved ones for the entire period of rehabilitation.
11. The doors of your room should be kept closed.

All restrictions are temporary, after 30 days a person will be able to return to his usual way of life.

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 cells (C) in the thyroid gland produce calcitonin - it controls Ca metabolism. Thyroid hormones can only be produced if iodine levels are normal; 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 do not care 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 is a 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 contain food additive E127 - red food coloring - it is added to canned meat, salami, canned fruit with cherries and strawberries; sweets and marshmallows of pink color. 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. The side effects and consequences of radioactive iodine treatment are short-lived, but you need to be aware of them.

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, supposedly, 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.