Radioiodine 131 treatment
Radioiodine therapy is an effective nuclear medicine method for treating hyperactive thyroid (hyperthyroidism) and some forms of thyroid cancer (papillary and follicular). The procedure neutralizes hyperactive or malignant cells without damaging healthy tissues. Many clinical studies confirm I-131 therapy as a safe, well-tolerated, and reliable method.
Radioiodine therapy is a well-proven form of nuclear medicine therapy carried out since the middle of the last century. Doctors use radioactive iodine (RAI) to treat an overactive thyroid (hyperthyroidism) and certain types of thyroid cancer.
The drug enters the bloodstream and is taken up by any thyroid cells. Radioactive I-131 has beta radiation and is exclusively stored in the thyroid cells (so-called thyrocytes). Finally, radioactive particles emit radiation and gradually destroy cancer cells. It is a safe, well-tolerated, and reliable method that targets thyroid cells, so there is little exposure to healthy tissues.
How is radioactive iodine carried out?
After registration at the clinic, the patient undergoes a comprehensive examination, which includes instrumental and laboratory tests:
- PET-CT or MRI;
- Ultrasound of the neck and abdomen;
- Functional scintigraphy;
- A panel of thyroid hormones (TSH, free T4, thyroglobulin);
- General and biochemical blood tests;
Radioactive iodine therapy is prescribed the next day if the examination results are satisfactory.
The doctor will give you a dose of iodine drug in a special protection ward. The amount depends on the results of blood tests and scans. Interventional radiologists distinguish several forms of radioactive iodine treatment:
- If you are taking radioactive iodine in pill-capsule form, it can be from 1 to 4 tablets, depending on the dose.
- If you receive radioactive iodine in liquid form, you will drink about a teaspoon of this medication (approximately 5 millilitres) from a small vial through a straw. It is a clear liquid, practically odourless and tasteless. Many patients report that it tastes the same as water, but some feel a slightly stale or musty aftertaste.
Right after the administration, radioactive I-131 will bind to the thyroid cells and emit radiation into the area. Doctors control the result by treatment duration and dosage. The main advantage of targeted treatment is working only for thyroid cells (including thyroid malignancy).
On the 3rd day of stay in the clinic, the patient is usually sent for dynamic scintigraphy in the gamma camera. This test allows the doctor to determine the places of the most active accumulation of the particles in the gland and throughout the body. Finally, each patient receives follow-up recommendations from the radiologist and responsible oncologist.
Who is the candidate for I-131?
Oncologists and radiation specialists increasingly use radioiodine therapy to treat many thyroid diseases. For example, I-131 is actively used in treating autoimmune gland issues, various forms of locally advanced and metastatic thyroid cancer, and diffuse goitre.
Doctors prescribe radioiodine therapy (I-131) in case of such diseases and conditions:
- Thyroid cancer (papillary and follicular);
- Toxic adenoma of the thyroid gland;
- Nodular/multinodular enlarged thyroid gland (so-called goitre);
- In case the surgical treatment is not possible;
- After thyroid operation (to remove remaining thyroid cancer cells);
- Transferred surgery on the thyroid gland.
But the most frequent indication for the procedure is primary and metastatic thyroid cancer. As a result, conservative radioiodine therapy replaces standard surgical treatment in some thyroid cancer patients. In addition, the technique has high efficiency, even in treating the most aggressive medullary carcinoma.
Advantages of radioactive iodine for thyroid cancer
The radioactive iodine destroys precisely those thyroid cells that need to be treated. It is a non-invasive, well-tolerated, targeted procedure. There can be no damage to the vocal cord nerves or an injury to the small parathyroid glands. Therefore, the risk of bleeding is limited.
Treatment with radioactive iodine is considered safer than surgery. Among the most evident and significant advantages of radiotherapy with iodine can be highlighted:
- Complete absence of recovery period.
- There is no need to put the patient under anaesthesia.
- Absence of aesthetic defects on the skin.
In the case of thyroid gland cancer, I-131 therapy is also carried out a few weeks after the operation to destroy any remaining thyroid cells in the body. Doctors concluded that having I-131 treatment decreases the rate of cancer relapse and should be routinely performed worldwide.
What are the side effects and risks associated with I-131 treatment?
Radioactive iodine treatment is pretty safe. However, there are specific details that every patient should be informed of. Naturally, the accumulation of iodine-131 in the thyroid tissue causes a so-called radiogenic inflammation, which can occur from 2 to 5 days. Therefore, taking the therapy capsule is usually asymptomatic. However, compared to diagnostic methods, the radiation exposure is higher and can look similar to the health impact of anaesthesia.
Some reports of adverse reactions following the use of sodium iodide RAI include nausea, vomiting, and nonspecific allergic reactions. Most often, nausea and vomiting are noted after oral administration.
In occasional cases, depending on the underlying thyroid disease, local complaints in the front of the neck (e.g. a feeling of pressure or sore throat) and, much less frequently, earache can occur. In addition, other types of severe long-term effects are sporadic overall. For example, depending on the therapy activity, there may be a tear or saliva secretion drop with corresponding dry eyes or mouth.
The therapeutic activity of radioiodine can temporarily cause an increase in existing hyperthyroidism. High levels can cause gastrointestinal upset, especially in the first hours and days after use. Gastrointestinal disorders can be observed in more than 67% of cases and are easily prevented by symptomatic treatment.
Recovery after radioiodine therapy
The following day after radioiodine, the dosimetrist will measure radiation levels in your body using a unique hand-held device. There is also a minimum of 48-hour isolation after taking a radioiodine therapy capsule in a special room.
When the level of radiation is low enough, the patient can leave the hospital. Patients follow additional radiation safety instructions after discharge. Typically, patients are recommended to avoid excessive physical activity a few days after the procedure. As a rule, after 10-12 days, a person completely forgets about any temporary discomfort.
Why is iodine 131 used in thyroid cancer?
Radioactive iodine is an effective method of treating papillary and follicular thyroid cancer, as these cancers can accumulate iodine drugs. Most often, the therapy is prescribed after surgery - removal of the thyroid gland, which makes it possible to find and kill the remnant cells and metastases.
Is radioiodine I-131 safe?
Extensive follow-up studies for over 70 years in many European countries and the United States show a minimal risk of treatment with radioactive iodine. Moreover, the benefit of treating the overactive thyroid gland far outweighs the shallow risk for most patients.
How will I feel after radioactive iodine?
Slight nausea occurs immediately after taking radioactive iodine. Your healthcare provider will give you anti-nausea medicine before your therapy. Also, a person may feel heaviness and compression in the neck. It can manifest in difficulty swallowing and swelling.
What doctor performs I-131 treatment?
A radionuclide radiologist (nuclear medicine doctor) performs I-131 treatment. It is done in departments of radiation therapy or radiation oncology. The other specialists involved in radioactive iodine therapy may include radiation oncologists and radiologists.
How long do you have to be isolated after radioactive iodine?
The length of hospital stay depends very much on the size of the thyroid gland. It is usually between two and twelve days. However, the treatment can also be designed individually, so multiple sessions are planned.
Where can I get Radioiodine therapy?
What are the best clinics for Radioiodine therapy?
Who are the best doctors for Radioiodine therapy?
Prof. Dr. med. Wolfgang Weber from University Hospital Rechts der Isar Munich
Prof. Dr. med. Hans-Jurgen Biersack from Beta Clinic Bonn
Prof. Dr. med. Frank Grunwald from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Peter Bartenstein from University Hospital Ludwig-Maximilians Munich
Prof. Dr. med. Stefan Dresel from Helios Hospital Berlin-Buch
Price of Radioiodine therapy
The price of radioactive iodine therapy varies depending on the chosen clinic, the number of necessary diagnostic procedures and the administration form. Total cost usually includes:
- A preliminary examination;
- I-131 therapy;
- Follow-up examinations (dosimetry, PET-CT, scintigraphy);
- Hospitalisation and recommendations for further treatment.
Therefore, the average price range is from 6,500 € to 14,300 €.