Treatment with radioactive iodine of the thyroid gland: price and reviews. Features of the treatment of the thyroid gland with radioactive iodine: the consequences of a non-surgical technique with local irradiation of the organ

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

Thyroid disease

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

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

Therapy for thyrotoxicosis and cancer

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

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

Why not an operation?

Sometimes an alternative therapy for thyrotoxicosis is surgery. Of course, the operation is always associated with great risk, not to mention the fact that the scar on the skin is not a very aesthetic thing. The anesthesia itself, the risk of bleeding, the possibility of damage to the recurrent nerve - all these are factors that speak against surgery in favor of a more gentle, but effective radioiodine therapy. Of course, in some cases, emergency measures simply cannot be dispensed with, as in the case of cancer.

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

World practice

Mild forms of the disease are preferred to be treated with medication. Also, this method is started when problems arise in adolescents and children. In other cases, it is better to treat thyrotoxicosis with radioactive iodine. The drug has the form of a capsule or an aqueous solution.

By the way, in Europe, doctors generally trust various antithyroid drugs more than radioactive iodine treatment. But in the United States, preference is given to radioiodine therapy as more effective. Of course, after it you need to go through a rehabilitation program, but taking medication also requires further recovery of the body.

The first introduction of radioisotopes of iodine was carried out in 1941 in the USA. And since 1960, the method has been widely used in medicine. Over the past period, we have become convinced of its usefulness, reliability and safety. And the price of radioactive iodine treatment has become more affordable. In some clinics in America and Europe, treatment with small doses of iodine is already being carried out on an outpatient basis. We also allow such a regimen, but only for doses within 10.4 mCi in terms of activity. Abroad, the norms are somewhat different, allowing for a stronger effect, which also has a positive effect on treatment.

The basis of the method

In medicine, the isotopes I 123 and I 131 are used. The first is for diagnosis, since it does not have a cytotoxic effect. But the second isotope just allows for treatment. It emits ß- and ɣ-particles. ß-radiation produces an irradiating effect localized in the tissues of the thyroid gland. ɣ-radiation allows you to control the dose and distribution of the drug. The thyroid gland accumulates this radioisotope of iodine I 131, and it, in turn, damages the thyroid tissue, which is the therapy for thyrotoxicosis.

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

Hypothyroidism, in turn, is corrected with medication. L-thyroxine preparations are prescribed, which compensates for the necessary hormones, usually produced by the thyroid gland. Although this hormone is synthetic, it is practically not inferior to the endogenous one. Control over the level of hormones, no doubt, is necessary, sometimes the dosage needs to be changed, but otherwise, patients return to their usual way of life.

Purpose of treatment

Now even our experts are inclined to believe that it is necessary to conduct a single treatment with radioactive iodine in Moscow or other cities in order to cause the development of hypothyroidism. Treatment with small doses simply reduces the symptoms, removes the problem only for a while, which is not as effective as complete elimination. The dosage of the drug is calculated for each patient individually. This indicator depends on the volume of the gland, the severity of the disease, its stage, the absorption test and the routine of scintigraphy.

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

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

The consequences of taking the drug

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

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

Restrictions after treatment

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

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

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

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

Thyroid treatment with radioactive iodine

The use of iodine I-131 helps with therapy:

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

They also treat cancer with radioactive iodine.

Possible complications of the use of radioactive iodine

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

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

Contraindications

Treatment with radioactive iodine should not be carried out during pregnancy. Pregnant women have an increased risk of developing serious complications, the procedure can harm the fetus. Nursing mothers should stop breastfeeding their baby.

The use of radioactive iodine in thyrotoxicosis and hyperthyroidism

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

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

Preparation for treatment

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

What is the essence of the procedure

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

How dangerous is radioactive iodine to others

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

Is it possible to receive visitors

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

Actions after radioiodine treatment

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

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

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

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

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

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

Treatment with radioactive iodine: the cost of the procedure

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

Conclusion

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

Compiled by: Baranovsky O.A., Deputy Chief Physician for Radiological Service, Minsk City Clinical Oncology Center

Treatment with radioactive iodine is required to control possible changes in the organs and systems associated with your thyroid disease.

We hope that the information presented below will answer many of your questions, but may raise others. If you have questions that are not covered in the attached sections, or if you do not understand any expressions, please contact your doctor or any member of the nuclear medicine department. If you suffer from hyperthyroidism (overactive thyroid), one of the treatments recommended for you may be radioactive iodine treatment.

1. What is radioactive iodine?
Radioactive iodine (I131) is a radioactive form of iodine that is used to diagnose and treat various human thyroid disorders.
Iodine is an element necessary for the normal functioning of the thyroid gland. It is located at the base of the neck, along the front surface, and is involved in the metabolic processes of almost all vital organs and systems of the body. Like ordinary iodine, radioactive iodine penetrates and accumulates in the cells of the thyroid gland. This allows it to be used in testing, diagnosing and treating thyroid disorders. The therapeutic effect is based on the radioactivity of I131, which irradiates the entire gland from the inside with beta and gamma radiation. 90% of the therapeutic effect is due precisely to beta radiation with a range of radioactive particles of 2-3 mm. Radioactivity destroys both gland cells (the remnants of the tissue itself) and tumor cells that have spread beyond it. The treatment is almost painless.

2. What is the radioactive iodine-131 test for?
This examination is prescribed for patients who have undergone surgical removal of the thyroid gland. After the operation, thyroid hormones are not prescribed. After 4 weeks, the patient is given radioiodine. Possible remnants of thyroid tissue and tumor cells have the ability to capture iodine and glow it. A day after taking a radioiodine capsule on a special device, shown in the photo below, information is received from the neck area about the presence or absence of functioning tissue.
An examination is immediately performed on a gamma camera in order to visually determine the location of the possible location of the tissue. If the test is positive, then further radioiodine therapy is necessary. The latter is also carried out according to other examinations on the prevalence of your disease (ultrasound, x-ray, laboratory).

3. How is radioactive iodine administered?
Ingestion of radioactive iodine is usually done by mouth, by swallowing the usual form and size of gelatin capsules containing the radioactive element itself. Capsules without taste and smell are swallowed without chewing, and washed down with one or two glasses of water (not juice). In exceptional cases, you may be offered a liquid form of radioiodine with similar characteristics. In this case, after taking it, it is necessary to rinse the mouth well with water, and immediately drink the latter. If you wear removable dentures, you will most likely be asked to remove them before taking liquid iodine.

4. Is radioactive iodine really dangerous to others?
The use of radiation for your treatment is for your benefit. However, it is harmful to those who come into contact with you. To reduce the risk of exposure to others, you will be placed in a separate room or a room with a patient with a similar disease. The nursing staff will not be able to stay with you for more than the time necessary to attend to your needs and will wear gloves and other protective clothing.

5. Is radioiodine harmless to you?
Radioiodine therapy is widely recognized as an effective treatment for thyroid disorders. Side effects are mild and stop on their own, provided that the recommendations for their prevention are followed. In order to protect the gastric mucosa, 30 minutes before taking the isotope, you will be given an antacid medicine (for example, Almagel or Gefal). After taking radioiodine capsules, you must additionally drink 2 glasses of mineral water. In the near future, "sore throat", nausea, vomiting, weakness and lack of appetite, local swelling on the neck are possible, later exacerbation of chronic diseases, acute gastritis, cystitis and sialadenitis (inflammation of the salivary glands) are possible. Inflammation of the salivary glands occurs in 30% of patients and can be acute or chronic. Symptoms of sialadenitis may appear within 24 hours and are more typical for patients who have received high activity of radioiodine, in the presence of small remnants of functioning thyroid tissue. To prevent the development of this complication, it is recommended to use chewing gum, lollipops, lemons, apply cold compresses and drink plenty of water. There may also be temporary pain in the tongue or a decrease in taste sensitivity. As a percentage, transient gastritis is noted in 30%, a decrease in the level of leukocytes and platelets - in 70%, a local tumor on the neck with pain syndrome - in 10-20% of patients. Literature data on the subsequent development of leukemia, pulmonary fibrosis, lesions of the gonads and bone marrow are very rare; in our practice, such complications have not been encountered. Implementation of recommendations for increased water load, stimulation of saliva production, as well as prescribed drugs to protect the gastric mucosa and antiemetics reduce the risk of these reactions to a minimum.

6. What medications can I take?
Thyroid hormone tablets - levothyroxine interfere with treatment or examination with radioiodine. Given this, you need to stop taking them 4 weeks before the planned intake of radioiodine (hospitalization). During this time, you may feel tired or weak, especially in the afternoon, weight gain, swelling of the face and limbs, coarsening of the voice, constipation, increased manifestations of calcium deficiency (if they were previously available) are also possible. Refusal to take levothyroxine, as a rule, leads to this (this is normal).
In addition, the following experiences and sensations are possible:
- depression,
- forgetfulness
- dry skin and hair,
- chilliness
- weight gain
- constipation
- violation of the menstrual cycle in women,
- decreased attention
- apathy,
- fast fatiguability.
These manifestations will disappear within 1-2 weeks after the start of taking levothyroxine again.
Many cough mixtures, mineral and nutritional supplements, and heart remedies contain significant amounts of iodine. The latter is captured by the remnants of the thyroid gland or tumor cells in the same way as radioiodine. At the same time, the effectiveness of radioiodine diagnostics or radioiodine therapy decreases, and the examination result is distorted. When taking calcium preparations, it is necessary to stop using it for 1 month before the treatment with "marine calcium". Please bring any other tablets and medicines you have taken in the last 4 weeks with you and show them to your doctor. Please also tell us about any X-ray examinations that you have had, as some of them require the use of iodine-containing substances. Fixed assets, studies recommended for cancellation, and cancellation deadlines are presented in the following table.

7. Can I receive visitors?
All visitors after taking radioiodine are excluded. That is, you will not be able to have physical contact with your visitors. The only communication with visitors is possible through the medical staff and broadcasts. You must not give them anything, including leftover food, drinks, printed matter, or clothing. Please ask the medical staff if you have any doubts about an item.
Pregnant women and children under 18 years of age are prohibited from any visits to patients receiving both treatment and examination with radioiodine.

8. What to do after taking radioactive iodine?
For better absorption, obtaining a good therapeutic effect with a lower radiation load on the stomach, after taking capsular or liquid radioiodine, it is not necessary to consume additional food and drink during the first hour. After swallowing a radioiodine capsule, it accumulates in the thyroid gland, its possible remnants (after surgery) or in other altered organs. Its excretion is carried out with urine, feces, saliva, sweat and breath. As a result, radioactivity can be deposited on surrounding objects: clothing, bedding, walls and personal belongings - on everything that you come into contact with. Therefore, each patient can take with him only strictly necessary personal items and will be provided with underwear and hospital gowns. Given the above, the following rules of conduct must be adhered to.
8.1 You must first change into hospital underwear.
8.2. When making a morning toilet or using water, washing your face and brushing your teeth, make sure that water does not splash outside the washbasin.
8.3. Be sure to thoroughly rinse your toothbrush after each use.
8.4. When visiting the bathroom, make sure that urine does not splash outside the toilet, and flush twice with a full tank of water. All patients (and men) from the beginning of treatment to discharge use the toilet only while sitting.
8.5. If you accidentally splash or spill something, please report it to the nurse or nurse.
8.6. For nausea and vomiting, use plastic bags in the ward or toilet bowl, with a mandatory message to the staff on duty. When using the toilet, flush the vomit twice. When vomiting in the ward - only in a bag, in extreme cases - on the bed, but not in the sink.
8.7. It is necessary to wash hands, both before eating and before other manipulations.
8.8. Do not use reusable cloth handkerchiefs, it is advisable to have disposable paper ones.
8.9. Flush used toilet paper down the toilet.
8.10. Your front door must be kept closed at all times.
8.11. Throw away chewing gum immediately after the taste disappears in plastic trash cans. Also put all leftover food in bags only.
8.12. Do not feed birds and animals through open windows.
8.13. Don't forget to shower daily.
8.14. It is necessary to have a chair every day, in case of its absence, inform the staff - you will be offered laxatives.
8.15. Before discharge, exit from the department only in shoe covers on shoes.

9. Length of hospital stay
In our country, radioiodine therapy is not possible on an outpatient basis. Reception, treatment and further examination are connected with the requirements of radiation safety. In this regard, after taking I131, each patient is placed for a certain period in a closed ward, without the possibility of free exit and movement.
All medical staff are specially trained in handling radioactive materials and the radiation aspects of your therapy.
From the 3rd day from the start of treatment, the dosimetrist will take daily measurements - measurements of the radioactivity remaining in your body. The data obtained is reported to the staff of doctors and nurses. When the level of radioactive iodine is low enough, you will be examined with a gamma camera. And only when your doctor is satisfied with your condition and the results of the examination, you will be discharged.
The average length of hospital stay is four to seven days. How soon you can return home depends only on the level of residual radioactivity in your body. Most of the radioactive components are captured by the thyroid gland during the first 24 hours. As soon as the radioactivity in your body has reached a safe level, you can be discharged with the permission of your doctor.

10. What is a scintigraphic examination on a gamma camera?
A scintigraphic examination allows you to determine the place of fixation of radioactive iodine in your body. When performing scintigraphy (scanning), it is necessary that you lie motionless on the surface of the table of the gamma camera during the entire examination. This painless procedure lasts a maximum of 60 minutes. If you cannot lie on a flat surface for a long time or are afraid of closed spaces, please let us know in advance. The device does not irradiate you, on the contrary, you are the source of radiation.
The result will be an image of the distribution of radioiodine in your body on a display screen or other medium. This helps to identify the effectiveness of previous treatment and establish the prevalence of the process. According to the scintigraphy data and other indicators, the tactics of treatment and management of the patient are subsequently chosen.

11. Are repeated courses of treatment necessary?
The condition of some patients requires two or more courses of treatment. Each case of thyroid disease is individual. At the time of discharge, the doctor will discuss with you the need for re-treatment and the approximate timing of its implementation. The latter may undergo changes based on the results of your examination (the level of a tumor marker in the blood - thyroglobulin, ultrasound examination and / or X-ray data).

12. Radioiodine and pregnancy
Pregnancy is an absolute contraindication to examination and treatment using all radioactive substances and radioiodine in particular. Every woman of childbearing age without a period is considered pregnant until proven otherwise.
If you underwent surgery on the thyroid gland and radioiodine treatment was recommended after it, then women are advised to plan pregnancy no earlier than a year after such treatment, and men - no earlier than 2 months.

13. Nutrition advice
In preparation for radioiodine therapy, patients are usually advised to follow a diet low in iodine.
The purpose of the low-iodine diet is to reduce the body's iodine content and thus increase the diagnostic or therapeutic efficacy of radioactive iodine. If such a diet is observed, by the time radioiodine is introduced into the body, cells capable of absorbing it experience iodine hunger. Therefore, they are able to absorb radioactive iodine more actively. In a healthy person, the main organ that absorbs iodine is the thyroid gland. If the thyroid gland was removed as a result of surgery, the detection of foci of radioiodine absorption in other organs (for example, in the lymph nodes, lungs) will help to more accurately determine the spread of the disease and choose the best treatment options. And since radioactive iodine is able to kill "bad" cells, it is used in such situations and for treatment.
A low-iodine diet is prescribed for a relatively short period of time, usually 2 weeks before radioiodine intake and continues throughout the course of diagnosis or treatment.
The following are recommendations for following a low-one diet. However, each patient requires an individual approach, so you need to hear the final recommendations from the doctor.
Remember that a low-nutrition diet does not mean salt-free, that is, you do not need to stop eating salt. You can use non-iodized salt and salt your food the way you are used to.
A low-iodine diet does not mean a complete lack of iodine in your diet. When following this diet, foods high in iodine (more than 20 micrograms per serving) should be excluded and foods with a moderate content of iodine (5-20 micrograms per serving) should be limited as much as possible.
You can eat foods that do not exceed 5 micrograms of iodine per serving. There are many foods that are so low in iodine that their consumption does not affect the outcome of your examination and treatment.
We suggest you familiarize yourself with the list of foods that should not be consumed on a low-one diet and which should be limited.

Foods and Supplements to Avoid on a Low One Diet
1. Any seafood: sea fish, crabs and crab sticks, shrimps, mussels, seaweed (cabbage, etc.) and preparations containing seaweed ("Fitosplat", etc.).
2. Dairy products (cheeses, sour cream, yoghurts, butter, ice cream, dry milk porridge, etc.).
3. Egg yolk, eggs with iodine, as well as dishes in the preparation of which egg yolk is used in large quantities. Egg white does not contain iodine, it can be consumed without restrictions if you follow a low-one diet,
if you have no other contraindications for it (if it is impossible to refuse the use of eggs, it is necessary to reduce their consumption to 3 per week).
4. Industrial bakery products containing preservatives with iodine. Cornflakes. You can be sure your diet is low in iodine by eating homemade baked goods made with non-iodized salt and no iodine-rich ingredients (such as egg yolks).
5. All foods and dishes that are red, orange and brown, as well as medicines that use dyes of these shades. Many of them contain iodine dye (erythrosine - E127), which is not always indicated on the product label. Therefore, it is better not to eat such colored foods.
6. Milk chocolate. Ice cream. You can use a small amount of cocoa powder and some varieties of dark chocolate. However, it is necessary to control the composition of chocolate products by carefully reading the information on the packaging.
7. Soy products (sauces, milk, tofu cheese). They contain iodine in fairly large quantities.
8. Red, purple, variegated beans. Iodine-containing vitamins and nutritional supplements; preparations containing iodides or iodates.
9. If you need vitamins during the low-one diet, take those that do not contain iodine. The composition of the drug is always indicated on the package.
10. Salted nuts, chips, canned fruits and canned meats, salami, instant coffee, oriental food, pizza, ketchup, french fries, applesauce, bananas, cherries, dried apricots.
11. Greens: dill, parsley, lettuce, watercress; cauliflower, green peppers, baked jacket potatoes, zucchini, olives, persimmons.

Foods and Ingredients Containing a Minimum Amount of Iodine
- fresh fruits and juices: apple, avocado, cantaloupe, grapefruit and other citrus fruits, peach, raisins, pineapple;
- vegetables, raw and freshly prepared (except for dark-colored beans, soy products and potatoes with skins), vegetables frozen without salt;
- coconut, unsalted peanuts and peanut butter;
- in moderation - cereal products (cereals, pasta), poultry meat (turkey, chicken) and other fresh meats (beef, veal, lamb), freshwater fish;
- sugar, but better - honey, jelly, fruit syrups, jams;
- black pepper, fresh and dried herbs,
- vegetable oils (except soybean) and salad dressings containing permitted ingredients;
- egg noodles, brown and white rice;
- home-cooked meals with low-iodine products using non-iodized salt;
- non-alcoholic carbonated drinks (cola, diet cola, lemonade, drinks that do not contain erythrosin dye), filtered coffee, tea.

14. Recommendations after discharge
After discharge, the patient is advised to adhere to the following rules.
- At home or at work, try to sit and stand at a sufficient distance from others - at least 1 meter. When staying in close proximity for a sufficiently long time (more than 1 hour), keep a distance of 2 meters.
- Avoid sex and sleep alone for three days (one week if your wife is pregnant).
- Within 8 days, do not approach more than 1-2 meters to young children (under 3 years old); if your children are between 3 and 10 years old, if possible, avoid close contact with them, such as long hugs, do not carry them in your arms; if childcare is required for children under 2 years of age, they should be cared for by someone else (arrange for temporary accommodation with relatives and friends if possible).
- Wash your hands thoroughly with soap and water every time you go to the toilet.
- Rinse the bath (sink, shower) several times after use.
- When using the toilet, flush the water 2-3 times within 2 weeks after receiving radioiodine. Men are advised to sit down when urinating to avoid urine splashing and use toilet paper.
- It is recommended that you always use methods of contraception that are acceptable to you (for women - within 6-12 months, for men - at least the first 2 months). Additional information can be obtained from a doctor.
- If you breastfed your baby before receiving radioactive iodine, then after a course of diagnosis or treatment, breastfeeding is interrupted, and the baby is transferred to artificial feeding.
- All personal clothing used during the stay in the hospital is washed separately, placed in a separate plastic bag (bag) and not used for 1.5 months.
- Continue to use chewing gum, lemon and sour sucking sweets as often as possible during the week (for the fastest cleansing of the salivary glands from radioactive iodine).
- If possible, avoid or limit contact with pregnant women, try to keep a distance of at least 2 meters from them.
- Kindergarten teachers, teachers and other workers who have close contact with children under 10 years of age should be suspended from work for a period determined by your oncologist.
- In small amounts after discharge, radioactive iodine will continue to be excreted through salivation and sweating. Therefore, cutlery, washcloths, towels, sheets, etc. must be strictly individual. After a normal wash, these things are cleaned. There is no particular need to wash such things separately.
- If you suddenly had to go to the hospital, or were taken there on an emergency basis, please tell your doctor that you have recently taken radioactive iodine. This is required even if you are taken to the same hospital where you received radioiodine therapy.
You can find more information yourself on the Internet, in the medical section of the library, or in a bookstore. Because not all information found may be accurate, remember that your healthcare provider is your best source of information.

radioactive iodine

Radioactive iodine (iodine-131, I131, radioiodine) is one of the isotopes of ordinary iodine-126, widely used in medical practice. Iodine-131 has the ability to spontaneously decay (half-life 8 days) with the formation of xenon, a gamma-ray quantum and a beta particle (fast electron).

Formed by the decay of radioactive iodine beta particle It has a high ejection speed and is able to penetrate into the biological tissues surrounding the isotope accumulation zone at a distance of 0.6 to 2 mm. It is this type of radiation that provides the therapeutic effect of radioactive iodine, since it causes cell death.

Gamma radiation freely penetrates the tissues of the human body, and can be recorded using special devices - gamma cameras. This type of radiation does not have a therapeutic effect, it is used to detect those places where the accumulation of radioactive iodine has occurred. Scanning the whole body with a gamma camera reveals foci of accumulation of radioiodine, and this information can be very important in the treatment of patients with malignant tumors of the thyroid gland, when the foci of "glow" after radioactive iodine therapy can be used to draw a conclusion about the localization of additional foci of the tumor (metastases) in the patient's body.

gamma camera
Scanogram of the patient's body after radioactive iodine therapy (multiple tumor foci in the bones are visible)	A scan of the patient's body after radioactive iodine therapy (tumor foci in the lungs are visible)

The use of iodine in the body

In the tissue of the thyroid gland, its cells do not lie randomly, but in an orderly manner - the cells of the gland form follicles (spherical formations with a cavity inside). The wall of the follicles is formed by thyroid cells (the so-called A-cells, or thyrocytes).

The production of thyroid hormones does not occur directly, but through the formation of an intermediate substance, a kind of "unfinished" hormone - thyroglobulin. In translation, its name means "protein of the thyroid gland." Thyroglobulin is synthesized only in the cells of the thyroid gland - this is very important to understand. Normally, nowhere in the body, except for the tissue of the thyroid gland, thyroglobulin is not produced.. The structure of thyroglobulin is very simple - it is a chain of amino acids (amino acids are the building blocks of any protein, thyroglobulin contains the widespread amino acid tyrosine), while each tyrosine residue is “hung” with two iodine atoms.

To build thyroglobulin, amino acids and iodine are taken by gland cells from vessels lying next to the follicle, and thyroglobulin itself is secreted into the follicle, into its lumen.

In fact, thyroglobulin is a "reserve" of iodine and already practically made hormones for 1-2 months. In a twisted form, it is in the lumen of the follicle until the body needs the active thyroid hormones - thyroxine and triiodothyronine. When there is a need for hormones, thyroid cells capture thyroglobulin "by the tail" and drag it through themselves in the direction of the vessels.

During such transport through the cell, thyroglobulin is cut into residues of 2 amino acids each. If there are 4 iodine atoms on two amino acid residues, such a hormone is called thyroxin (usually abbreviated as T4 - by the number of iodine atoms in the hormone molecule).

In the body, thyroxine has few effects - it is not very active. In fact, thyroxine is also a precursor hormone. In order for it to be fully activated, one iodine atom “breaks away” from it to form the hormone T3 or triiodothyronine. T3 contains three iodine atoms. The process of T3 synthesis is very similar to the process of tearing out the checks from a grenade (“they torn off” an iodine atom - the hormone became active), and it takes place not in the thyroid gland, but in all tissues of the human body.

Follicular and papillary thyroid cancer cells also retain the ability to produce thyroglobulin. Of course, they do this almost 100 times weaker than normal thyroid cells, but the production of thyroglobulin in these cells still occurs. Thus, in a patient with follicular or papillary thyroid carcinoma, thyroglobulin is produced in two places: in normal thyroid cells and in cells of papillary or follicular carcinoma.

Therapeutic effects of radioactive iodine

The therapeutic effect of radioactive iodine is based on the effect of beta radiation on body tissues. It should be especially emphasized that cell death occurs only at a distance of up to 2 mm from the isotope accumulation zone; radioactive iodine therapy has a very targeted effect. If we take into account that iodine itself in the human body actively accumulates only in the thyroid gland (in a much smaller amount - in the cells of differentiated thyroid cancer, i.e. in the cells of papillary cancer and follicular thyroid cancer), it becomes obvious that radioactive iodine treatment is a unique method that allows you to "point" influence on iodine-accumulating tissues (thyroid tissue or tissue of thyroid tumors).

Indications for radioactive iodine treatment

Treatment with radioactive iodine can be indicated to the patient in two cases.

1. The patient has diffuse toxic goiter or nodular toxic goiter, i.e. a condition in which the tissue of the thyroid gland excessively produces hormones, which is the cause of the development of thyrotoxicosis - an "overdose" of thyroid hormones. Symptoms of thyrotoxicosis are increased sweating, rapid and arrhythmic heartbeat, a feeling of "interruptions" in the work of the heart, irritability, tearfulness, and increased body temperature. There are two types of toxic goiter - diffuse toxic goiter and nodular toxic goiter. With diffuse toxic goiter, the entire thyroid tissue produces hormones, and with nodular goiter, only the nodes formed in the thyroid tissue.

The goal of radioactive iodine treatment in this case is to suppress the functional activity of overworking areas of the thyroid gland. After taking radioactive iodine, it accumulates precisely in those places that are “responsible” for the development of thyrotoxicosis, and destroys them with its radiation. After radioiodine therapy, the patient recovers normal thyroid function or gradually develops hypothyroidism (hormone deficiency), which is easily compensated by taking an exact copy of the human hormone T4 - L-thyroxine.

2. The patient has malignant tumor thyroid gland capable of accumulating radioactive iodine (papillary thyroid cancer, follicular thyroid cancer). In this case, the first stage of treatment is the complete removal of the thyroid gland with a tumor, and, if necessary, the lymph nodes of the neck affected by the tumor. Treatment with radioactive iodine is carried out to destroy areas of the tumor located outside the neck (in the lungs, liver, bones) - metastases. In patients with malignant tumors of the thyroid gland, treatment with radioactive iodine can significantly reduce the likelihood of cancer recurrence. This method is the only one that allows you to destroy distant metastases located in the lungs and liver. It is important to note that radioiodine therapy provides good treatment results even in patients with distant metastases. In the vast majority of cases, patients with papillary and follicular thyroid cancer completely get rid of their disease.

Body scan of a patient with metastases of papillary thyroid cancer to the lungs after the first course of radioactive iodine treatment	A body scan of a patient with metastases of papillary thyroid cancer after the third course of radioactive iodine treatment (the accumulation of the isotope in the lungs has disappeared, which indicates the death of tumor cells)

Efficacy and safety of radioactive iodine treatment

Treatment with radioactive iodine is one of the highly effective methods of treatment. Its peculiarity is the use of small amounts of the isotope, selectively accumulating precisely in those areas where their impact is necessary. So, in comparison with the widely used in Russia in thyroid cancer(and not directly recommended for use by European agreements) external beam radiation therapy, radioiodine therapy with a comparable initial dose of exposure provides a tumor focus with an almost 50 times higher radiation dose, while the total effect on body tissues (skin, muscles, bone marrow) turns out to be about 50 times smaller. The selective accumulation of iodine-131 and the slight penetration of beta-particles into tissues allows "point" treatment of tumor foci, suppressing their viability and without harming surrounding tissues. In a 2004 study by Martin Schlamberger of the Institute Gustave Roussy (Paris), it was shown that radioactive iodine treatment achieves a complete cure of more than 86% of patients with thyroid cancer metastases to the lungs, while the 10-year survival rate in this group of patients was 92%. This testifies to the exceptionally high efficiency of radioiodine therapy, because we are talking about patients with the very last (IVc) stage of the disease. In less advanced cases, the effectiveness of treatment is even higher.
Of course, treatment with radioactive iodine can lead to the development of some complications. Unfortunately, absolutely safe methods of treatment still do not exist. In the treatment of patients with thyroid cancer with radioactive iodine, both low (30 mCi) and high (up to 150-200 mCi) doses of radioactive iodine are used. Given that in patients undergoing such cancer treatment, thyroid tissue has already been completely removed by the time iodine is taken, some iodine may accumulate in the salivary glands, which can lead to the development of sialadenitis - inflammation of the salivary gland tissue, manifested by swelling, induration, soreness. Sialadenitis develops only with the use of high iodine activities (dose of 80 mCi and above) and practically does not occur with low-dose therapy, which is indicated for most patients with small tumors (dose of 30 mCi).
A decrease in the reproductive ability of patients can only occur with repeated treatment with radioactive iodine using high activities, when the total (cumulative) dose of treatment is exceeded 500 mCi. In practice, the use of such activities is rarely needed.
Until now, the question of the possibility of the appearance of tumors of other organs due to radiation due to radioiodine therapy for thyroid cancer is still controversial. One study noted that after treatment with radioactive iodine for thyroid cancer using a fairly high dose (100 mCi), there was a slight increase in the incidence of leukemia and tumors in other organs, but the risk was assessed by the investigators as very small (53 new tumors and 3 cases of leukemia per 100,000 patients treated with radioactive iodine). It is easy to guess that in the absence of radioactive iodine treatment, mortality in this group of patients from thyroid cancer would significantly exceed the above figures. That is why it is now generally accepted that the benefit / risk ratio for radioiodine therapy is definitely in favor of a positive effect of treatment.
One of the latest trends in the treatment of thyroid cancer with radioactive iodine has been the use of low doses of iodine (30 mCi), which, according to studies in 2010, are similar to those of high doses, and the likelihood of complications is much lower. Widespread use of low-dose therapy makes it possible to practically neutralize the negative effects of radioiodine therapy.

Treatment with radioactive iodine toxic goiter(diffuse toxic goiter, nodular toxic goiter) is usually carried out using low drug activities (up to 15-30 mCi), while the patient has completely preserved (and even increased) the functional activity of the thyroid gland by the time of treatment. This leads to the fact that a small dose of iodine that has entered the body is quickly and completely captured by the thyroid tissue. As a result, complications from radioiodine therapy of toxic goiter are very rare.
It should be noted that the effectiveness of radioactive iodine treatment of toxic goiter directly depends on the method of preparing the patient for treatment and the prescribed dose of iodine-131. The method of calculating the dose of radioactive iodine widely used in our clinics on the basis of accumulative tests in some cases leads to the appointment of patients with unreasonably low (6-8 mCi) activities of the drug, which causes the development of a relapse of thyrotoxicosis in patients after treatment. In a significant number of clinics in Europe, the standard practice is to use fixed activities of radioactive iodine (for example, 15 mCi), which provides more optimal treatment results compared to using unnecessarily low doses. It should be noted that higher doses of iodine do not cause any significant negative effect in this case, since we are talking about very small differences in dose (recall that single doses of up to 200 mCi are used in the treatment of thyroid cancer!), And also because radioactive iodine completely captured by the thyroid gland and does not enter other organs.

Situation in Russia

Unfortunately, in the last 30 years, clinics for the treatment of radioactive iodine have practically not been built in our country. Despite a significant number of patients requiring this type of treatment, there are only a few centers in Russia that provide radioiodine therapy. This generates long waiting lists for treatment, and also deprives the patient of the opportunity to choose a clinic. Another important consequence of this shortage of places for radioactive iodine treatment is the high prices supported by Russian medical institutions. Surprisingly, in a number of European clinics, the prices for the treatment of thyroid cancer with radioiodine are comparable to Russian prices(with much better living conditions and absolutely incomparable quality of scanning equipment, which allows to identify the location of metastases). In clinics of the CIS countries, prices for the treatment of thyroid cancer can be up to 2 times lower than in Russia, with a high quality of treatment. As for radioiodine therapy of diffuse toxic goiter, the same trend can be traced here - the prices of European clinics are lower than the prices of Russian monopolists or comparable to them. Of course, it should also be mentioned that there is no need to wait in line for treatment in European clinics.

In recent months, there has finally been a tendency to correct the situation: in Moscow, the TsNIIRRI opened a department of radioactive iodine therapy, which became the second Russian medical institution that treats patients with thyroid cancer with radioactive iodine. It is important to note that in this institution, treatment is possible within the framework of the federal quota program, i.e. is free. The issue of queues and prices for patients undergoing radioiodine therapy in this institution on a paid basis still needs to be clarified.

There are also data on the construction of radioiodine therapy departments in other Russian cities, but so far there have been no reports of completed projects in this industry.

Opportunities for Radioiodine Treatment in Europe

Of all European countries, the most attractive countries for radioactive iodine treatment are the Scandinavian countries (primarily Finland) and the Baltic countries (primarily Estonia). The clinics of these countries are located very close to the Russian border, to visit these countries you need a regular Schengen visa, which is now available to many residents of Russia (especially residents of the North-West region, for whom trips to Finland and Estonia have long become one of the options for spending the weekend ), finally, the cost of travel to clinics in these countries is quite comparable to the cost of travel within Russia, and sometimes even lower. One of the important features of these clinics is the presence of Russian-speaking staff, helping patients from Russia to feel comfortable.

An exceptionally significant advantage of European clinics is the possibility of individually determining the dose of radioactive iodine for each individual patient. In Russian clinics, the standard dose of radioiodine in the treatment of thyroid cancer is 81 mCi. The reason for prescribing the same dose to all patients is very simple - the capsules with the drug come to Russia packaged at 3 gBq (gigabecquerel), which corresponds to a very unusual dose of 81 mCi. At the same time, in the countries of Europe and the USA, the tactics of differentiated (individual) prescription of radioactive iodine dosages in accordance with the aggressiveness of the tumor detected in the patient is generally accepted. Patients with small tumors are prescribed a dose of 30 mCi, with aggressive tumors - 100 mCi, in the presence of distant tumor metastases (to the lungs, liver) - 150 mCi. Individual planning of doses of the drug avoids the effect of "overtreatment" (overtreatment) in patients from the low-risk group and at the same time achieves a high effect of radioactive iodine treatment in patients from the group with a high risk of tumor recurrence.

It is worth mentioning the differences in the duration of the patient's stay in clinics in Europe and Russia. After the Chernobyl disaster, the requirements for ensuring the radiation regime on the territory of our country were not revised for a very long time. As a result, domestic standards, on the basis of which the time of discharge of a patient from a clinic for the treatment of radioactive iodine, is determined, are much more “rigid” than the standards of European countries. Thus, after treatment of diffuse toxic goiter with radioiodine, a patient in Russia spends 4-5 days in a hospital (in Europe, treatment is carried out without hospitalization, the patient stays in the clinic for about 2 hours); after treatment for thyroid cancer, the patient spends 7 days in a Russian clinic (in Europe - 2-3 days). In domestic clinics, patients are either in single rooms (which is quite tiring for the patient, since he is deprived of the opportunity to communicate), or in double rooms (which makes it possible to communicate, but exposes the patient to additional radiation due to close contact with a neighbor, who is also a source of radiation). ).

The last advantage of radioactive iodine treatment in European clinics is the possibility of using Thyrogen, a synthetic recombinant human thyroid stimulating hormone produced by the American corporation Genzyme, in patients with thyroid tumors. Currently, the vast majority of patients undergoing radioiodine therapy for thyroid cancer in Europe and the United States are prepared for treatment by two intramuscular injections of "Tyrogen" (two and one days before receiving radioactive iodine). Tyrogen has not yet been registered in Russia, although it is used in the vast majority of countries around the world, so our patients with thyroid cancer are preparing for radioactive iodine treatment by stopping L-thyroxine 4 weeks before treatment. This method of preparation provides high-quality radioiodine therapy, but in some patients (especially young people) it can cause pronounced symptoms of hypothyroidism (weakness, lethargy, drowsiness, feelings of "chillness", depression, edema). The use of "Thyrogen" allows patients to continue therapy with L-thyroxine until the very date of radioiodine therapy and relieves them of the development of symptoms of hypothyroidism. Unfortunately, the cost of this drug is quite high and amounts to about 1600 euros. Residents of European countries in the overwhelming majority of cases, the cost of the drug is compensated by medical insurance companies, while Russian citizens who want to use this method of preparing for therapy have to pay for it from their own funds. However, even the fact that patients have the opportunity to choose the method of preparation is also a definite advantage of choosing radioactive iodine treatment in Europe. We emphasize once again that the preparation of "Thyrogen" can only be used to treat patients with thyroid cancer; patients with toxic goiter do not need it.

So, the main advantages of radioactive iodine treatment in European clinics are:
- prices for treatment (comparable to Russian prices or lower);
- lack of queues for treatment;
- no need for hospitalization (for patients with toxic goiter) or a short hospital stay (for patients with thyroid cancer);
- high quality of diagnostic equipment (in European clinics, SPECT / CT devices are used for scanning, allowing you to superimpose the image obtained by scanning the patient's body on the image obtained using a computed tomograph - this significantly increases the sensitivity and specificity of the study);
- good conditions of stay in the clinic;
- the possibility of using the preparation "Thyrogen".

Memo of the patient during the course of therapy

radioactive iodine (I-131).

Federal State Institution "RNCRR" of the Ministry of Health and Social Development of the Russian Federation (www.) admits and hospitalizes patients operated on for papillary and follicular thyroid cancer for radioiodine therapy.

Hospitalization of citizens of the Russian Federation is carried out in accordance with the rules for the provision of high-tech medical care, citizens of other states - on a paid basis.

· It is recommended to avoid conception: for women - within 6-12 months, for men - during the first 2 months after treatment, since the radioactive drug you received comes into contact with germ cells, and slightly increases the risk of genetic disorders. After this period, conception will be no more dangerous than in people who have not received radioiodine treatment. If necessary, consult with a specialist.

· If you breast-fed your child before receiving radioactive iodine, then after the course of treatment, breast-feeding is interrupted and the child is transferred to artificial feeding.

Continue to use chewing gum, lemon and sour sucking sweets as often as possible during the week (for the fastest cleansing of the salivary glands from radioactive iodine).

· Kindergarten teachers, teachers and other workers who have close contact with children under 10 years of age should be suspended from work for a period of at least 1 month.

· If you suddenly have to go to the hospital, or you are taken there on an emergency basis, please tell your doctor that you have recently taken radioactive iodine. This is required even if you are taken to the same hospital where you received radioiodine therapy.

· If you plan to visit facilities equipped with radiation monitoring systems (airports, train stations, some metro stations, customs and border posts, etc.), we recommend that you carry and present to security officers the original extract from the hospital, which will allow you to avoid a number of inconveniences ( denial of access to the facility, additional personal search, removal from the flight, etc.).