Introduction of radioactive iodine into the thyroid gland. Therapeutic treatment of the thyroid gland with radioactive iodine. Preparation for radioiodine therapy

Iodine is Chemical substance, which 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 purple during its combustion.

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, brain and all internal organs. Thyroxin can be compared to fuel for the body, like gasoline for a car. Thyroxin 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 transport 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, which have the same number of protons, but a different number of neutrons, while the 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 (to preserve the voice) and 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 digestive tract and in 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, among patients with thyroid cancer, there are three risk groups. 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 of more 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).

Group high risk.

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 without fail treatment with radioactive iodine at a dose of 100 mCi or more is indicated.

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 important properties TSH is the stimulation of thyroid cell growth. 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: pulse becomes slow (bradycardia), mild arterial hypertension(increased blood pressure), in some patients, atherosclerosis may progress.

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 exercise endure hard. 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 exclude 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, 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 a long "starvation" they greater strength begin to capture radioactive iodine from the blood. 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 recommendations 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 period of isolation (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 radioactive iodine treatment, such as going to work, talking with friends, walking in crowded places, do not exceed one day. Patients who comply 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 are certainly not dangerous to anyone, but modern devices they can detect radiation from you and give a signal to the appropriate services about it. 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 of occurrence and severity of the course. 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 surgical intervention 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 a diagnostic scan, the dose of radioactive iodine does not exceed 1-5 mCi, and in such cases unwanted effects 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 probability 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 may be prescribed anti-inflammatory drugs with a good healing 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 pronounced in patients with chronic diseases. gastrointestinal tract. As a rule, in a clinic where radioactive iodine treatment is carried out, they talk about the correct water regimen and, if necessary, prescribe drugs that protect the stomach and intestines (antacids).

Inflammation of the salivary glands (sialadenitis).

A person has three pairs (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 - 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.

may apply depending on the situation. various schemes treatment of sialadenitis. 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 touched with the palm of the hand mandible 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 in as soon as possible seek help from a specialist. As a rule, patients get a consultation with a maxillofacial surgeon, who, after examination and necessary research defines medical 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 in only 1-5% of patients treated with radioactive iodine. Inflammation of the lacrimal gland is also rare. In the event of any discomfort in the eye area, consult 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 rare, but decreased function may occur after receiving radioactive iodine parathyroid glands(hypoparathyroidism). 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 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 gestation or development 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 (tumors hematopoietic system originating from cells bone marrow), compared with 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 remote control. radiotherapy. 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

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 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 further complicated by the large number of blood vessels in the tissue 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 optimal dose 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 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 those around him.

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 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 of the 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 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 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 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, a patient must have high level 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 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. it modern way return what was lost good health with minimal health risk.

) differentiated cancer thyroid gland.

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

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

The concept of the method

Radioiodine therapy uses radioactive iodine medical literature it can be called iodine-131, radioiodine, I-131) - one of the thirty-seven isotopes of the well-known iodine-126 to all of us, which is available in almost every first-aid kit.

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

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

The equally high penetrating power of gamma particles allows them to easily pass through any tissue of the patient's body. For their registration, high-tech equipment is used - gamma cameras. Not producing any therapeutic effect, gamma radiation helps to detect the localization of radioiodine accumulations.

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

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

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

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

Indications and contraindications

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

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

Radioiodine therapy has proven effective in the treatment of Graves' disease, as well as nodular toxic goiter (otherwise referred to as functional autonomy of the thyroid gland). In these cases, radioactive iodine treatment is used instead of surgery.

The use of radioiodine therapy is especially justified in case of recurrence of the pathology of an already operated thyroid gland. Most often, such relapses occur after operations to remove diffuse toxic goiter.

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

An absolute contraindication to the appointment of radioid therapy is:

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

Pros and cons of the procedure

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

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

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

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

Which is better, surgery or radioactive iodine?

Opinions on this matter are contradictory even among specialists involved in the treatment of thyroid diseases.

Some of them believe that after (a surgical operation to remove the thyroid gland), a patient taking estrogen-containing drugs can lead a completely normal life, since a regular intake of thyroxine can replenish the function of the missing gland without causing side effects.
Proponents of radioiodine therapy emphasize that this type of treatment completely eliminates the side effects (the need for anesthesia, removal of the parathyroid glands, damage to the recurrent laryngeal nerve) that are inevitable during a surgical operation. Some of them are even cunning, claiming that radioiodine therapy will lead to euthyroidism (normal functioning of the thyroid gland). This is an extremely erroneous assertion. In fact, radioiodine therapy (as well as thyroidectomy surgery) is aimed at achieving hypothyroidism - a condition characterized by complete suppression of the thyroid gland. In this sense, both methods of treatment pursue completely identical goals. The main advantages of radioiodine treatment are complete painlessness and non-invasiveness, as well as the absence of the risk of complications arising after surgery. Complications associated with exposure to radioactive iodine, in patients, as a rule, are not observed.

So what is the best technique? In each particular case the last word remains with the attending physician. In the absence of contraindications to the appointment of radioiodine therapy in a patient (suffering, for example, Graves' disease) he will most likely advise you to prefer it. If the doctor believes that it is more expedient to perform a thyroidectomy, you need to listen to his opinion.

Training

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

It is advisable not to allow iodine to enter the surface skin: patients are forbidden to lubricate wounds with iodine and apply to the skin iodine grid. Patients should refuse to visit salt room bathing in sea water and inhalation of sea air saturated with iodine. Residents of the sea coasts need isolation from the external environment at least four days before the start of therapy.
Under strict ban vitamin complexes, nutritional supplements and medications containing iodine and hormones: they should be discontinued four weeks before radioiodine therapy. A week before taking radioactive iodine, all medications prescribed for the treatment of hyperthyroidism are canceled.
Women childbearing age required to take a pregnancy test: this is necessary to eliminate the risk of pregnancy.
Before the procedure for taking a capsule with radioactive iodine, a test is carried out for the absorption of radioactive iodine by the tissues of the thyroid gland. If the gland was removed surgically, an iodine sensitivity test of the lungs is performed and lymph nodes, since it is they who take on the function of accumulating iodine in such patients.

Diet before therapy

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

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

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

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

Patients undergoing radioiodine therapy should completely abstain from:

Seafood (shrimp, crab sticks, sea fish, mussels, crabs, algae, seaweed and dietary supplements based on them).
All types of dairy products (sour cream, butter, cheeses, yoghurts, dry milk porridges).
ice cream and milk chocolate(a small amount of dark chocolate and cocoa powder is allowed to be included in the patient's diet).
Salted nuts, instant coffee, chips, canned meat and fruit, french fries, oriental dishes, ketchup, salami, pizza.
Dried apricots, bananas, cherries, applesauce.
Iodized eggs and foods with a lot of egg yolks. This does not apply to the use egg whites, not containing iodine: during the diet, you can eat them without any restrictions.
Dishes and products colored in different shades of brown, red and orange, as well as medicines containing food dyes of similar colors, since many of them may contain iodine-containing dye E127.
Bakery products of factory production containing iodine; corn flakes.
Soy products (tofu cheese, sauces, soy milk) rich in iodine.
Greens of parsley and dill, leaf and watercress.
Cauliflower, zucchini, persimmons, green peppers, olives, potatoes, baked in a "uniform".

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

Peanut butter, unsalted peanuts, coconuts.
Sugar, honey, fruit and berry jams, jellies and syrups.
Fresh apples, grapefruits and other citrus fruits, pineapples, cantaloupe, raisins, peaches (and their juices).
White and brown rice.
Egg noodles.
Vegetable oils (except soy).
Raw and freshly cooked vegetables (excluding potatoes, beans, and soybeans).
Frozen vegetables.
Poultry meat (chicken, turkey).
Beef, veal, lamb meat.
Dried herbs, black pepper.
Cereal dishes, pasta (in limited quantities).
Carbonated soft drinks (lemonade, erythrosin-free diet cola), tea, and well-filtered coffee.

Treatment with radioactive iodine of the thyroid gland

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

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

The selective accumulation of the radioactive isotope and the shallow penetration of beta-particles into the thickness of biological structures provides the possibility of a point effect on the tissues of tumor foci with their subsequent destruction and complete safety in relation to adjacent organs and tissues.

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

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

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

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

Radioiodine is excreted through stool, urine, secretion of sweat and salivary glands, patient's breath. That is why the radiation will settle on the objects of the environment surrounding the patient. All patients are warned in advance that a limited number of things should be taken to the clinic. Upon admission to the clinic, they are required to change into the hospital linen and clothes issued to them.

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

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

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

Treatment after thyroidectomy

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

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

Patients treated with radioactive iodine must:

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

Effects

Radioiodine therapy can cause certain complications:

Sialadenita - inflammatory disease salivary glands, characterized by an increase in their volume, compaction and soreness. The impetus for the development of the disease is the introduction of a radioactive isotope against the background of the absence of a remote thyroid gland. In a healthy person, thyroid cells would fire up to eliminate the threat and absorb the radiation. In the body of the operated person, this function is taken over by the salivary glands. The progression of sialadenitis occurs only when a high (above 80 millicurie - mCi) radiation dose is received.
Various violations reproductive function , but such a reaction of the body occurs only as a result of repeated exposures with a total dosage exceeding 500 mCi.

Treatment of thyroid cancer with radioactive iodine is an alternative method that is used if 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 determines 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 the vital important 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 % therapeutic effect is achieved due to beta particles, which have a high speed of movement and a small range in the 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 treatment is used for patients who have undergone prompt removal 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 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 re-development disease, and the occurrence of metastases.

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

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.
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.
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 not useful to everyone.

Main contraindications:

pregnancy;
large or multinodular goiter;
individual intolerance to iodine;
lactation;
thyroiditis after childbirth;
psychiatric illnesses;
hepatic, kidney failure;
severe form of decompensated diabetes;
hypoplastic, aplastic anemia;
stomach ulcer, duodenum during 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 influence 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 relapse rate;
there are no scars after the procedure;
minimal amount 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.

Suspense 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.
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 individual features patient.

In addition, there are certain general recommendations to prepare the body for the effects of an isotrope.

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

Required Diet

Power adjustment is also important condition preparing the patient for radioiodine therapy. Diet implies 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.

You can also eat unsalted nuts, vegetable oil, sugar, honey, fruit jam, tea, raisin compote, 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 the capsule or water solution radioactive iodine and drink plenty of water (at least 400 ml).

The patient is then isolated in separate room, as exposure from it poses 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 figure drops to 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 manifests itself 24 hours after the procedure and is often caused by the introduction of an isotrope into in large numbers against the background of residual tissues of the thyroid gland.

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 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. For elimination unpleasant consequences symptomatic therapy is prescribed.

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.

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.
It is necessary to take a shower at least 2 times a day.
Approaching others and pets should be no more than 1 m, it is forbidden to kiss and hug children.
Sleep alone and in a separate room.
Men should urinate while sitting.
After visiting the toilet, flush the tank twice with the used toilet paper and wash your hands thoroughly with soap.
All personal hygiene items should be kept in a plastic bag.
It is recommended to use separate dishes.
Bed sheets and clothes should be washed daily.
If possible, limit contact with loved ones for the entire period of rehabilitation.
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 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:

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

The I-131 isotope seeps into thyroid cells, 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 body.

After the surgical intervention.
When the patient's body does not perceive well or does not react at all to drugs.
Patients over 60 years of age.
If a relapse occurs, for example, in the treatment of cancer or diffuse goiter.
Patients who, for some reason, cannot undergo surgery and drug treatment has no effect.
Patients with serious cardiovascular problems.

Radioiodine therapy gives 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 prescribed full examination. Indicators of the state of the thyroid gland are needed to determine the required concentration of the isotope.

The goal pursued when preparing a 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.

Enhanced Level 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 is high performance TSH, the absorption process increases, but their destruction process also increases accordingly.

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

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.
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 replacements 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 cancer cells 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 vegetarian diet. The purpose of the diet: conditions must be created for maximum absorption of radioiodine by thyroid cells. Preparatory process 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.

Should not be used 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 such a period should not happen additional problems with health. 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:

Daily diet should provide physical activity of a person.
The menu should include only permitted products.
The number of products is limited, but not minimal, should not provoke a deterioration in health.
When following a diet, do not use semi-finished products.
Use regular salt.
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;
may change taste sensations;
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.