home Audience 1 Information for patients receiving treatment with radioactive iodine (radiiodine therapy). Features of treatment of the thyroid gland with radioactive iodine: consequences of a non-surgical technique with local irradiation of the organ Why is radioactive iodine dangerous?

Information for patients receiving treatment with radioactive iodine (radiiodine therapy). Features of treatment of the thyroid gland with radioactive iodine: consequences of a non-surgical technique with local irradiation of the organ Why is radioactive iodine dangerous?

Radioactive iodine– a chemical element that is used to treat various diseases thyroid gland.

Without iodine, the body cannot function normally, work endocrine system is under constant threat.

The radioactive form of this substance accumulates in the thyroid gland, after which it is possible to determine the condition of the organ.

Typically, this procedure is prescribed to people who have undergone surgery on the thyroid gland after 4 weeks.

A capsule with radioactive iodine is taken once, and within a day a special study is carried out that helps healthy and functioning tissue.

The essence of exposure to radioactive iodine

After radioactive iodine enters the body, it begins to affect the cells of the thyroid gland: both healthy and damaged areas of tissue die.

The procedure for exposure to radioactive iodine must be directed, since the distance between cells and isotopes should not exceed 2 millimeters.

Due to their low penetrating ability, beta rays do not have a pathogenic effect on surrounding tissues and do not in any way affect the condition of other organs and systems.

As a result of radioactive iodine therapy, the thyroid gland stops producing, which leads to the development.

Typically this procedure is prescribed for the following diseases:

and various on it.
Transferred earlier.
, caused by the presence on the thyroid gland.
caused by long-term hyperthyroidism.
High risk of complications after surgery on the endocrine gland.

It is very important that the use of radioactive iodine for the treatment of large nodules follows a biopsy of a portion of each nodule and cytology of each material.

You also need to remember that this method of therapy is applicable only for highly differentiated cancer - and.

In all other cases, this method will not show the desired result; other treatment methods are applicable to them.

Preparing to administer radioactive iodine

In order for the results from using radioactive iodine to be maximum, it is necessary to follow a number of certain rules for some time.

This will help prepare not only the thyroid gland, but also the entire body from negative influences.

A person’s condition after radiotherapy depends entirely on the completeness of compliance with the doctor’s recommendations.

To ensure the intervention is safe, you must adhere to the following rules:

Tell your doctor in advance if you use any medications– some of them will have to be canceled 4 days before thyroid radiotherapy.
Women should make sure that they are not pregnant.
Before starting the intervention, it is necessary to carry out a comprehensive assessment: determine how it can accumulate chemicals.
Several weeks before the intended radiotherapy, you must adhere to.

Your diet should contain a minimum amount of iodine so that the thyroid gland can fill as many tissues as possible with the radioactive form.

It is important to follow a special low-calorie diet, which your doctor will tell you about. It is necessary to prepare long and thoroughly for irradiation of the thyroid gland with radioactive iodine.

Benefits of Iodine Radiotherapy

Treatment of the thyroid gland with radioactive iodine is considered safer than surgery.

In some cases, this procedure must be performed 4 weeks after surgery.

Among the most obvious and significant advantages of iodine radiotherapy are:

Complete absence of recovery period.
There is no need to put the patient under anesthesia.
No aesthetic defects on the skin.

The procedure for introducing radioactive iodine into the body is carried out once.

Usually a person does not feel any discomfort However, if swelling or itching occurs, topical medications must be used.

The received dose of radiation is absorbed only into the thyroid gland; the components of radioactive iodine do not spread throughout the body.

Disadvantages of radiotherapy with iodine

Many patients are categorically against radioactive iodine therapy.

They believe that after such an intervention there will certainly arise serious complications, which lead to serious disorders of the body.

Of course, in rare cases, patients develop hypothyroidism after treatment of the thyroid gland with radioactive iodine - the person is forced to take hormonal medications for the rest of his life.

Also among the disadvantages of radioactive iodine therapy are:

Presence of contraindications.
Accumulation of isotopes in the mammary glands and appendages in women, in the prostate in men.
The development of hypothyroidism, due to which a person is forced to take hormonal medications for the rest of his life.
A complete ban on conception for six months after the intervention.
Changes in the functioning of the lacrimal and salivary glands Oh.
Exacerbation of some chronic diseases.
The appearance of chronic fatigue and constant mood swings.
Decreased visual acuity.

Side effects

Treatment with radioactive iodine is a very safe and, most importantly, effective procedure. For some patients, this intervention saved their lives.

However, due to individual characteristics body or an incorrectly selected dose, a person may develop serious complications.

Among them are temporary consequences:

Sore throat, constant feeling dry mouth.
Swelling of the neck, difficulty swallowing.
Pain in the neck and tongue, in the area of the salivary glands.
Change in taste preferences.
Regular attacks of nausea and vomiting.

Among the long-term consequences that require separate drug therapy are:

Mental disorders and depression due to decreased hormone production.
Decreased platelet and leukocyte levels in the blood.
Dry eyes caused by decreased functioning of the lacrimal glands.
Serious exacerbations of chronic diseases.
Fatigue, chronic fatigue.
Painful sensations in muscle tissue.

The use of radioactive iodine is strictly prohibited for pregnant or breastfeeding women. This may negatively affect the development of the fetus.

Despite its disadvantages and side effects, radiotherapy is considered an effective treatment for many thyroid diseases.

This intervention is safer than surgery. After radiotherapy, a person does not have scars or scars.

After 10-12 days, a person completely forgets about temporary discomfort. It is important to lead a healthy lifestyle after undergoing iodine radiotherapy.

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

Treatment with radioactive iodine is required to monitor possible changes in 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 any questions that are not covered in the attached sections, or if you do not understand any expressions, please contact your physician or any member of the Nuclear Medicine Department. If you suffer from hyperthyroidism ( increased function

thyroid gland), then one of the types of treatment recommended for you may be treatment with radioactive iodine.
1. What is radioactive iodine?
Radioactive iodine (I131) is a radioactive form of iodine that is used to test and treat various diseases of the human thyroid gland. 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 important organs

and body systems. Like regular 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 diseases. 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 to beta radiation with a range of radioactive particles of 2-3 mm. Radioactivity destroys both gland cells (remnants of the tissue itself) and tumor cells that have spread beyond its boundaries. The treatment is almost painless.
2. Why is the radioactive iodine-131 test necessary?
This examination is prescribed for patients who have undergone surgical removal of the thyroid gland. After surgery, 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, using a special device shown in the photo below, information is obtained from the neck area about the presence or absence of functioning tissue. An examination is immediately carried out using a gamma camera in order to visually determine the location possible location

fabrics.
Radioactive iodine is usually taken orally, by swallowing regular-looking and sized gelatin capsules containing the radioactive element itself. Tasteless and odorless capsules 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, you must rinse your mouth thoroughly with water and drink the latter immediately. If you wear removable dentures, you will 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 room with a patient with similar disease. Health care personnel will not stay with you longer than necessary to attend to your needs and will wear gloves and other protective clothing.

5. Is radioiodine safe for you?
Radioiodine therapy is widely known as effective remedy in the treatment of thyroid diseases. Side effects are mild and self-limiting if recommendations for their prevention are followed.. In the near future, there may be a “sore throat”, nausea, vomiting, weakness and lack of appetite, local swelling in the neck, later an exacerbation of chronic diseases, the phenomenon of acute gastritis, cystitis and sialoadenitis (inflammation of the salivary glands) is possible. Inflammation of the salivary glands occurs in 30% of patients and can be acute or chronic. Symptoms of sialadenitis can appear within 24 hours and are more common in patients who have received high levels of radioiodine and 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 fluids. There may also be temporary pain in the tongue or decreased taste sensitivity. As a percentage, transient gastritis is observed in 30%, a decrease in the level of leukocytes and platelets - in 70%, a local tumor in the neck with pain syndrome - in 10-20% of patients. Literary data on the subsequent development of leukemia, pulmonary fibrosis, gonadal damage and bone marrow

very rare, such complications have not been encountered in our practice. Following 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 levothyroxine tablets interfere with radioiodine treatment or testing. Given this, you need to stop taking them 4 weeks before you plan to take radioiodine (hospitalization). During this time, you may feel tired or weak, especially in the afternoon, weight gain, swelling of the face and limbs, deepening of the voice, constipation, increased manifestations of calcium deficiency (if they were previously present) are also possible.
Stopping levothyroxine will usually lead 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
- menstrual cycle,
among women,
decreased attention
- apathy,
Many cough syrups, mineral and nutritional supplements, and heart medications contain significant amounts of iodine. The latter is taken up by the remnants of the thyroid gland or tumor cells in the same way as radioiodine. In this case, the effectiveness of radioiodine diagnostics or radioiodine therapy is reduced, and the examination result is distorted. When taking calcium supplements, you must stop using them for 1 month before treatment." sea calcium"Please bring with you any other tablets and medications you have taken in the last 4 weeks and show them to your doctor. Also report any x-rays you have had, as some of them require the use of iodine. Basics remedies, studies recommended for cancellation, and withdrawal periods are presented in the following table.

Medicines	Cancellation dates
Thyreostatics (mercazolyl, propylthiouracil, tyrosol, etc.)	From 3 to 7 days
Natural and synthetic hormones thyroid gland	10 days for triiodothyronine and 4 weeks for levothyroxine
Expectorants, vitamins, nutritional supplements containing regular iodine	1-2 weeks depending on iodine content
Iodine-containing drugs (amiodarone, etc.)	1-6 months
Local application of iodine (treatment of skin, mucous membranes, etc.)	1-2 weeks
X-ray contrast agents for research	Cancellation dates
- water-soluble intravenous	3-4 weeks
- fat-soluble oral (for example, for cholecystography)	3 months
- oil (for example, during bronchography)	6-12 months
- oil (for example, during myelography)	2-10 years

7. Is it possible to receive visitors?
All visitors are excluded after taking radioiodine. That is, you will not be able to have physical contact with your visitors.
The only communication with visitors is possible through medical staff and transmissions. You must not give them anything, including leftover food, drinks, printed materials or clothing. Please ask the nursing staff if you have any doubts about any item.

Pregnant women and children under 18 years of age are prohibited from any visits to patients receiving both treatment and examination with radioiodine.
For better absorption and to obtain a good therapeutic effect with less radiation exposure to the stomach after taking capsule or liquid radioiodine, there is no need to consume additional food or 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. It is excreted through urine, feces, saliva, sweat and breath. As a result, radioactivity can settle on surrounding objects: clothing, bed, 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 clothes. Given the above, you must adhere to the following rules of conduct.
8.1 You must first be changed into hospital underwear.
8.2. When performing the morning toilet or using water, washing your face and brushing your teeth, make sure that water does not splash outside the sink.
8.3. Be sure to rinse your toothbrush thoroughly after each use.
8.4. When visiting the bathroom, make sure that urine does not splash outside the toilet, and flush with a full tank of water twice. 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 anything, please notify your nurse.
8.6. In case of nausea and vomiting, use plastic bags in the room or toilet, with the obligatory notification to the staff on duty. When using the toilet, flush vomit twice. If vomiting in the ward - only into a bag, in
extreme cases
- on the bed, but not in the sink.
8.7. It is necessary to wash your 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. Yours
Entrance door
must be closed at all times.
8.11. Throw the chewing gum into plastic bin bags as soon as the taste disappears. Also put all leftover food in bags only.
8.15. Before discharge, exit from the department only in shoe covers.

9. Length of hospital stay
In our country, radioiodine therapy is not possible on an outpatient basis. Reception, treatment and further examination are related to radiation safety requirements. In this regard, after taking I131, each patient is placed in a ward for a certain period of time closed type
, without the possibility of free exit and movement.
All medical staff are specially trained to work with 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 obtained data is reported to the staff of doctors and nurses. When your radioactive iodine levels are 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
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 attending physician.
10. What is a scintigraphic study using a gamma camera?

A scintigraphic study allows you to determine where radioactive iodine is fixed in your body. When performing scintigraphy (scanning), it is necessary that you lie motionless on the surface of the gamma camera table during the entire study. This painless procedure lasts a maximum of 60 minutes. If you cannot lie on a flat surface for long periods of time or are afraid of confined spaces, please inform us in advance. The device does not irradiate you; on the contrary, you are the source of radiation.
Some patients' conditions require two or more courses of treatment. Each case of thyroid disease is individual. Upon discharge, the doctor will discuss with you the need for re-therapy 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, data ultrasound examination

and/or x-ray).
12. Radioiodine and pregnancy Pregnancy is absolute contraindication
to examination and treatment with the use of all radioactive substances and radioiodine, in particular. Every woman of childbearing age without menstruation is considered pregnant until proven otherwise.

If you have undergone surgery on the thyroid gland and after it treatment with radioiodine was recommended, then women are advised to plan pregnancy no earlier than a year after such treatment, and men - no earlier than 2 months.
13. Dietary recommendations
In preparation for radioiodine therapy, patients are usually advised to follow a low-iodine diet.
The goal of a low-iodine diet is to reduce iodine levels in the body and thus increase the effectiveness of the diagnostic or therapeutic effects of radioactive iodine. When following such a diet, by the time radioiodine is introduced into the body, cells capable of absorbing it experience iodine starvation. 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 has been removed as a result of surgery, detecting foci of radioiodine uptake in other organs (eg, lymph nodes, lungs) will help more accurately determine the spread of the disease and choose the best treatment options. And since radioactive iodine is capable of killing “bad” cells, it is used in such situations for treatment.
A low-iodine diet is prescribed for a relatively short period of time: usually 2 weeks before taking radioiodine and continues throughout the course of diagnosis or treatment.
Remember that a low-iodine diet does not mean a salt-free diet, that is, you do not need to give up salt intake. You can use non-iodized salt and add salt to your food the way you are used to.
A low-iodine diet does not mean no iodine in your diet. When following this diet, you should exclude foods high in iodine (more than 20 mcg per serving) and limit foods with moderate iodine content (5-20 mcg per serving) as much as possible.
You can eat foods that contain no more than 5 mcg of iodine per serving. There are many foods that have such low iodine content that their consumption will not affect the outcome of your examination and treatment.
We invite you to familiarize yourself with the list of foods that should not be consumed when following a low-iod diet and which should be limited.

Foods and Supplements to Avoid When Following a Low-Iodine Diet
1. Any seafood: sea fish, crabs and crab sticks, shrimp, mussels, seaweed(cabbage, etc.) and preparations containing seaweed (Fitosplat, etc.).
2. Dairy products (cheese, sour cream, yoghurt, butter, ice cream, dry milk porridge, etc.).
3. Egg yolk, eggs with iodine, as well as dishes in which egg yolk is used in large quantities. Egg white does not contain iodine, if you follow a low-iodine diet, it can be consumed without restrictions,
if you have no other contraindications for it (if it is impossible to refuse to eat eggs, you need 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 if you eat homemade baked goods made with non-iodized salt and without 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 consume small amounts of cocoa powder and some types of dark chocolate. However, it is necessary to control the composition chocolate products
7. Soy products (sauces, milk, tofu). They can contain iodine in quite large quantities.
8. Red, purple, variegated varieties of beans.
Iodine-containing vitamins and nutritional supplements; preparations containing iodides or iodates.
9. If you need to take vitamins during a low-iodine diet, take those that do not contain iodine.
The composition of the drug is always indicated on the packaging.

10. Salted nuts, chips, canned fruit and canned meat, 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 minimal amounts of iodine
fresh fruits
and juices: apple, avocado, cantaloupe, grapefruit and other citrus fruits, peach, raisin, pineapple; - raw and freshly prepared vegetables (except for dark-colored beans, soy products and potatoes with peel), frozen vegetables without salt;;
- coconut, unsalted peanuts and peanut butter;
- in moderation - grain products (cereal dishes, pasta), poultry (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 dishes from products low in iodine using non-iodized salt;
- non-alcoholic carbonated drinks (cola, diet cola, lemonade, drinks that do not contain erythrosine dye), filtered coffee, tea. 14. Recommendations after discharge After discharge, the patient is advised to adhere to the rules outlined below.
- At home or at work, try to sit and stand at a sufficient distance from others - at least 1 meter. If you are in close proximity, it is enough
for a long time (more than 1 hour), maintain a distance of 2 meters.(up to 3 years); if your children are between 3 and 10 years old, if possible, avoid close contact with them, such as prolonged hugs, and do not carry them in your arms; If it is necessary to care for children under 2 years of age, someone else must look after them (if possible, arrange for temporary placement of children with relatives and friends).
- Wash your hands thoroughly with soap every time after using 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 to use methods of contraception that are acceptable to you (for women - for 6-12 months, for men - for at least the first 2 months). Consult your doctor for more information.
- If you breastfed your child before receiving radioactive iodine, then after a course of diagnosis or treatment, breastfeeding is interrupted and the child is transferred to artificial feeding.
- All personal clothing used during a hospital stay 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 suckers as often as possible for a week (for fastest cleansing salivary glands from radioactive iodine).
- If possible, you should avoid or limit contact with pregnant women, try to keep a distance of at least 2 meters from them.
- Kindergarten teachers, teachers and other employees who have close contact with children under 10 years of age should be suspended from work for a period determined by your oncologist.
- After discharge, radioactive iodine will continue to be released in small quantities through salivation and sweating.
Therefore, cutlery, washcloths, towels, sheets, etc. must be strictly individual. After normal washing, these items are cleaned. There is no particular need to wash such items separately.
You can find more information on your own on the Internet, 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.

Poor ecology, stress and other unfavorable conditions often lead to thyroid diseases. Its increase harms the body. Thyrotoxicosis can take many forms, including diffuse toxic goiter, also called Graves' disease or Graves' disease. Sometimes it comes to destroying the overgrown tissue of the gland and radioactive iodine is called upon.

Thyroid diseases

Thyrotoxicosis, which is hyperthyroidism, can take various forms. These include diffuse and Plummer's disease, Hashimoto's goiter and some other ailments. These diseases are successfully treated with radioactive iodine (in Moscow, for example, it is carried out at the Central Scientific Research Institute of Radioactive Indicators and some other clinics). This method is used to complement the treatment of many types of cancer and other thyroid tumors, including lymphoma and Hashimoto's thyroiditis.

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

Therapy of thyrotoxicosis and cancer

Most of these diseases are effectively eliminated by treatment with radioactive iodine. This type of therapy is also carried out in Moscow. Of course, it is first assigned conservative treatment, say, toxic adenoma or diffuse toxic goiter with the help of medications. But the efficiency rarely exceeds 40%, and is often almost half that. If similar treatment does not bring results or a relapse is observed, then the optimal 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, treatment with radioactive iodine in Moscow, as well as throughout the world, is carried out as a additional method therapy. Here it is important to adhere to the established deadlines after thyroidectomy and carry out treatment according to the protocol, then the risk of metastases can be minimized.

Why not surgery?

Sometimes an alternative to the treatment of thyrotoxicosis is surgery. Of course, surgery is always associated with great risk, not to mention the fact that a 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 more gentle, but effective radioiodine therapy. Of course, in some cases without emergency measures You just can’t do it, as in the case of cancer.

With the surgical method, part of the tissue was often preserved to prevent hypothyroidism. However, this approach is fraught with relapses 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 the full therapeutic effect instead of temporary. And the cost of treatment with radioactive iodine is more reasonable.

World practice

Mild forms of the disease are preferably treated with medication. This method is also used when problems arise in adolescents and children. In other cases, it is better to treat thyrotoxicosis with radioactive iodine. The drug comes in the form of a capsule or an aqueous solution.

By the way, in Europe, doctors in general trust various antithyroid drugs more than treatment with radioactive iodine. But in the USA, preference is given to radioiodine therapy as more effective. Of course, after it it is necessary to undergo a rehabilitation program, but taking medications also requires further restoration of the body.

Radioisotopes of iodine were first introduced 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 for treatment with radioactive iodine has become more affordable. In some clinics in America and Europe, treatment in small doses iodine treatment is already being carried out on an outpatient basis. We also allow this regimen, but only for doses within 10.4 mCi in activity. Abroad, the norms are somewhat different, allowing for a stronger effect, which also has a positive effect on treatment.

Basis of the method

In medicine, the isotopes I 123 and I 131 are used. The first is for diagnostics, since it has no cytotoxic effect. But the second isotope is what makes it possible to carry out 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 specifically 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 permissible limits. The cytotoxic effect is localized, destroying only thyrocytes, which leads to a decrease in the volume of the thyroid gland and a transition to hypothyroidism without surgical intervention.

Hypothyroidism, in turn, is corrected with medication. L-thyroxine preparations are prescribed, which replaces the necessary hormones normally produced by the thyroid gland. Although this hormone is synthetic, it is practically not inferior to the endogenous one. Monitoring hormone levels is undoubtedly necessary; sometimes the dosage needs to be changed, but otherwise patients return to to the usual way life.

Purpose of treatment

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

First, an examination is performed to determine accompanying pathologies, 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 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 extent of the process. Outpatient this procedure are not performed, preferring to leave the patient for two to three days in the clinic.

Consequences of taking the drug

You should be prepared for what will happen after treatment with radioactive iodine. In the next few days after taking the drug, radioactive iodine will leave the body through saliva and urine. These symptoms may last for varying periods of time, depending on age and the dose prescribed. At the same time, the elimination process is accelerated in young people compared to the situation in older people.

This has virtually no effect on your well-being. Only a few sensitive people who have undergone treatment with radioactive iodine report nausea during this period. Dry mouth or sore neck and throat may also occur. They report increased fatigue and metallic taste in the mouth. Sometimes it can cause constipation or diarrhea.

Restrictions after treatment

But there are a number of restrictions that serve as instructions for action. Thus, for a certain period of time it will be necessary to avoid close contact with other people so as not to expose them to radiation. You will have to sleep alone, refuse kisses and hugs, avoid sharing dishes, and observe similar measures. In this regard, a number of prescriptions for patient behavior can be identified.

Patients undergoing treatment with radioactive iodine, reviews confirm this, should pay more attention to hygiene for some time. So, it is better to flush the toilet twice; after visiting it, you should wash your hands especially thoroughly with plenty of water and soap. You will need separate dishes, towels, and bed linen that no one else will use. Naturally, linen and clothes should also be washed separately from relatives’ belongings. You should not cook food for your household.

It is better to collect even garbage in a separate basket, and then give it for disposal to a medical institution (if such a service is provided). Otherwise, you can throw it away in a regular trash can after 8 days. 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 cutlery are placed in the same separate garbage bag.

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 treating the thyroid gland with radioactive iodine. Read more about the principles of therapy, risks and consequences for the patient in the material.

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

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

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

Thyroid scintigraphy

Let's look at how to test the thyroid gland using iodine, and what the patient needs to know about the specifics of the test. Scintigraphy, or radioisotope scanning of the thyroid gland, is a method of functional study of the organ’s functioning, based on its ability to absorb radioactive iodine molecules.

Using scintigraphy you can evaluate:

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

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

Indications for the procedure

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

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

Also, according to the doctor’s indications, the procedure is carried out to monitor the treatment of thyroid diseases, evaluate the results of the operation, and provide medical examination to patients being observed for thyroid cancer.

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

The instructions for the procedure do not imply any special preparation for it.

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

if the patient is taking iodine preparations, they should be discontinued a month before the study;
after 3 weeks any diagnostic studies requiring intravenous administration of a radiopaque contrast agent.

How is radioisotope scanning performed?

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

Oral (by swallowing gelatin capsules) or intravenous administration of a radiodrug containing microdoses of I123, I131 or Tc99.
The distribution of radioiodine isotopes with the bloodstream throughout the body and their accumulation mainly in the tissues of the thyroid gland.
Placing the patient in a gamma chamber, in which the radiation force is read by the cells and radioactive iodine accumulates.
Transferring the received information to a computer, processing it and producing the finished result.

It is important to know. Price this study largely depends on the clinic in which it is performed. The average price of scintigraphy in private research centers is 3,000 rubles.

Evaluation of the results obtained

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

Table: Signs of thyroid pathology during radioisotope scanning:

Sign	The appearance of “cold” areas	The emergence of “hot” areas
Characteristic	Light areas appear against the background of uniformly colored thyroid tissue	Prominent, highly colored areas delimited by a light rim (steal syndrome)
What does this mean	“Cold” nodes indicate a decrease in the production of thyroid hormones in this area	“Hot” areas are a sign of increased functional activity of the thyroid gland and an increase in the concentration of thyroid hormones in the blood
Possible thyroid diseases	Fibrosis Chronic, including autoimmune, thyroiditis Thyroid cancer	DTZ (Graves' disease)

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

Just something complicated

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 and has a stable result, unlike 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 extremely carefully to prevent damage. The operation is complicated by even more blood vessels in endocrine gland tissue.

What is ablation?

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

Ablation means destruction or erosive ulceration. Ablation with radioactive iodine is prescribed by a doctor after accurately establishing the dose of the microelement. Uptake is determined during a scan and the doctor monitors the activity of the endocrine gland and the amount of radioactive iodine it takes up. In addition, during the examination, the specialist “sees” diseased and healthy tissues.

When determining the optimal dose of iodine important criteria speaks:

thyroid gland size;
absorption test result.

Accordingly, the dose of radioactive iodine is increased depending on the size of the thyroid gland and the more it absorbs, 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 enormous speed and provokes the death of its cells. The therapeutic effect is achieved using this type of radiation, which has a targeted effect on tissues that accumulate iodine.

The penetration of gamma radiation into the human body and organs is recorded in gamma cameras, which reveal areas of accumulation of the isotope. The glowing areas recorded on the images indicate the location of the tumor.

The cells of the thyroid gland 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 that contains tyrosine, which captures 2 iodine atoms.

Reserves of ready-made thyroglobulin are stored in the follicle; as soon as the body feels the need for endocrine gland hormones, they immediately release into the lumen of the blood vessels.

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

The doctor will explain in detail to the patient the rules of behavior to reduce the impact of radiation on others.

Who is prescribed treatment?

Among the applicants are patients:

with diagnosed diffuse toxic goiter;

The popularity of the method is ensured by its high efficiency. Less than half of patients with thyrotoxicosis receive adequate care when taking tablet medications. 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 tests and studies of the thyroid gland.
Calculate the approximate date of radioiodine therapy and stop taking antithyroid drugs 2 weeks before.

The effectiveness of treatment during the initial session reaches 93%, with repeated therapy 100%.

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

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

Short term side effects include:

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

Goiter

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

The goal is, when radioactive iodine is used, to treat 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 condition.

Treatment of diffuse toxic goiter with radioactive iodine will lead to a decrease in the hydration of the eyeball. This is an obstacle to wear contact lenses, so you will have to give them up for a few days.

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

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

Cancer

A cancerous tumor is a mutated normal cells. As soon as at least one cell acquires the ability to divide at a high speed, they speak of the formation of oncology. Interestingly, even cancer cells are able to produce thyroglobulin, but in much lower concentrations.

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

Treating thyroid cancer with radioactive iodine is justified by the small effect it has on the rest of your body. The radiation dose used is much higher than with scanning.

The procedure is effective when it is necessary to destroy thyroid tissue that remains after surgery after treatment for thyroid cancer, if the lymph nodes and other parts of the body are affected. Radioactive treatment of the thyroid gland 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 cancerous damage to the thyroid gland. Surgical removal of the entire organ is considered more effective.

To effectively treat thyroid cancer, the patient must have high level thyroid-stimulating hormone in the blood. It stimulates cancer cells and organ cells to take up radioactive iodine.

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

The patient must be warned about the occurrence of symptoms:

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

Risks and side effects

Patients taking therapy should be warned about the consequences:

Men who receive large total doses of radioactive iodine will have a reduced number of active sperm. Very rarely, there are cases of subsequent infertility, which can last up to 2 years.
Women after therapy should abstain from pregnancy for 1 year and be prepared for menstrual irregularities, since radioiodine treatment affects the ovaries. Accordingly, breastfeeding should be avoided.
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 his life. Radioiodine therapy has undeniable advantages over another radical solution - surgery.

The price of the procedure varies slightly in different clinics. Instructions have been developed that take into account all safety and efficiency requirements.

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

Treatment with radioactive iodine is sometimes the only chance to save a person suffering from one of the forms (papillary or follicular) of differentiated thyroid cancer.

The main goal Radioiodine therapy is the destruction of follicular cells of the thyroid gland. However, not every patient can receive 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 you receive treatment? All these questions can be answered in our article.

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

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

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

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

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

This information has 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 metastases of a malignant neoplasm.

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

The therapeutic effect, which occurs two to three months after the start of therapy, is similar to the result obtained by surgical removal of this organ. Some patients may be prescribed a second course of radioiodine therapy if the pathology recurs.

Radioiodine therapy is prescribed to treat patients suffering from:

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

Radioiodine therapy has proven its effectiveness in the treatment of Graves' disease, as well as nodular toxic goiter (otherwise known 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 relapse of the pathology of the already operated thyroid gland. Most often, such relapses occur after operations to remove diffuse toxic goiter.

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

An absolute contraindication to radioactive therapy is:

Pregnancy: exposure to radioactive iodine on the fetus can cause defects in its further development.
The period of breastfeeding a baby. Nursing mothers taking radioactive iodine treatment need to wean their baby off the breast for quite a long time.

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

It does not involve the need to put the patient under anesthesia.
Radiotherapy does not require a rehabilitation period.
After treatment with the isotope, the patient’s body remains unchanged: no scars or scars (inevitable after surgery) that disfigure the neck remain on it.
Swelling of the larynx and an unpleasant sore throat that develop in a patient after taking a capsule with radioactive iodine can be easily relieved with the help of topical medications.
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.
Since reoperation with malignant tumor thyroid gland can pose a threat to the patient’s life, 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:

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

Some of them believe that after a thyroidectomy (surgical operation to remove the thyroid gland), a patient taking estrogen-containing drugs can lead completely normal image life, since regular intake of thyroxine can replenish the function of the missing gland without causing side effects.
Proponents of radioiodine therapy focus on the fact that this type of treatment completely eliminates side effects (the need for anesthesia, removal of parathyroid glands, damage to the recurrent laryngeal nerve), inevitable during surgery. Some of them are even disingenuous, claiming that radioiodine therapy will lead to euthyroidism (normal functioning of the thyroid gland). This is an extremely erroneous statement. 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 treatment methods 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. Patients, as a rule, do not experience complications associated with exposure to radioactive iodine.

So which technique is better? In each specific case, the final word remains with the attending physician. If there are no contraindications to the prescription of radioiodine therapy in a patient (suffering, for example, from Graves' disease), he will most likely advise preferring it. If the doctor believes that it is more appropriate to perform a thyroidectomy, you need to listen to his opinion.

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

It is advisable to prevent iodine from getting on the surface of the skin: Patients are prohibited from lubricating wounds with iodine and applying iodine mesh to the skin. Patients should refuse to visit salt room, swimming in sea water and inhaling sea air saturated with iodine. Residents of sea coasts require isolation from the external environment for at least four days before starting therapy.
Vitamin complexes, nutritional supplements and medications containing iodine and hormones are strictly prohibited: they should be discontinued four weeks before radioiodine therapy. A week before taking radioactive iodine, all medications prescribed for the treatment of hyperthyroidism are discontinued.
Women of childbearing age are required to take a pregnancy test: this is necessary to eliminate the risk of pregnancy.
Before the procedure of taking a capsule with radioactive iodine, a test is performed to determine the absorption of radioiodine by the tissues of the thyroid gland.

If the gland has been surgically removed, a test is carried out for the sensitivity to iodine of the lungs and lymph nodes, since it is they who take on the function of accumulating iodine in such patients.

The first step in preparing a patient for radioiodine therapy is to follow a low-iodine diet, aimed at completely reducing the iodine content in the patient’s body so that the effect of the radioactive drug brings a more noticeable effect.

Since a low-iodine diet is prescribed two weeks before taking a capsule with radioactive iodine, the patient’s body is brought to a state of iodine starvation; as a result, tissues capable of absorbing iodine do so with maximum activity. Prescribing a low iodine diet requires individual approach

to each patient, therefore the recommendations of the attending physician in each specific case are of decisive importance.

A low-iodine diet does not mean that the patient must give up salt. You just need to use a non-iodized product and limit its amount to eight grams per day. The diet is called low-iodine because the consumption of foods with low (less than 5 mcg per serving) iodine content is still allowed.

Patients undergoing radioiodine therapy should completely stop using: Seafood (shrimp, crab sticks , sea fish, mussels, crabs, algae, seaweed
and dietary supplements created on their basis). All types of dairy products (sour cream, butter
Ice cream and milk chocolate (a small amount of dark chocolate and cocoa powder can 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 dishes with lots of egg yolks. This does not apply to the consumption of egg whites that do not contain iodine: during the diet you can eat them without any restrictions.
Dishes and foods 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.
Factory-produced bakery products containing iodine; cornflakes.
Soy products (tofu cheese, sauces, soy milk) rich in iodine.
Parsley and dill, leaf and watercress.
Cauliflower, zucchini, persimmons, green peppers, olives, potatoes baked in their jackets.

During the period of a low-iod diet, the following is allowed:

Peanut butter, unsalted peanuts, coconuts.
Sugar, honey, fruit and berry jams, jellies and syrups.
Fresh apples, grapefruits and other citrus fruits, pineapples, cantaloupes, raisins, peaches (and their juices).
White and brown rice.
Egg noodles.
Vegetable oils (except soybean).
Raw and freshly cooked vegetables (except potatoes with skins, beans and soy).
Frozen vegetables.
Poultry (chicken, turkey).
Beef, veal, lamb meat.
Dried herbs, black pepper.
Cereal dishes, pasta(in limited quantities).
Carbonated soft drinks (lemonade, diet cola that do not contain erythrosine), tea and well-filtered coffee.

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

It has been proven that, in comparison with external beam irradiation (with a comparable dosage of exposure), radioiodine therapy is capable of creating in the tissues of a tumor focus a dose of radiation that is fifty times higher than that of radiation treatment, while the effect on bone marrow cells and bone and muscle structures was tens times smaller.

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

How does the radioiodine therapy procedure work? During the session, the patient receives a regular-sized gelatin capsule (odorless and tasteless), which contains 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 in liquid form (usually in a test tube). After taking this drug, the patient will need to rinse his mouth thoroughly and then swallow the water used for this. Patients using removable dentures will be asked to remove them before the procedure.

In order for radioiodine to be better absorbed, ensuring a high therapeutic effect, the patient must 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 deleted surgically, the accumulation of the isotope occurs either in the tissues remaining from it, or in partially changed organs.

Radioiodine is excreted through feces, urine, secretions of the sweat and salivary glands, and the patient’s breath. That is why radiation will settle on objects 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 clothing issued to them.

After taking radioiodine, patients in an isolation ward must strictly adhere to the following rules:

When brushing your teeth, avoid splashing water. The toothbrush should be rinsed thoroughly with water.
When visiting the toilet, you must use the toilet carefully, avoiding splashing urine (for this reason, men should only urinate while sitting). It is necessary to wash off urine and feces at least twice, until the tank is full.
Any accidental splashing of fluid or secretions should be reported to the nurse or aides.
When vomiting, the patient should use a plastic bag or toilet (flush the vomit twice), but under no circumstances use a sink.
It is prohibited to use reusable handkerchiefs (there must be a supply of paper ones).
Used toilet paper is flushed away with the stool.
The entrance door should 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.
If there is no bowel movement (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 to visit a patient in strict isolation. This is done in order to prevent their radiation contamination by the flow of beta and gamma particles.

Radioiodine therapy is often prescribed to cancer patients who have undergone surgery to remove the thyroid gland. The main goal of such treatment is the complete destruction of abnormal cells that could remain not only in the area where the removed organ is located, but also in the blood plasma.

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

Patients treated with radioactive iodine are required to:

Increase the amount of fluid you drink to speed up the removal of iodine-131 breakdown products from the body.
Take showers as often as possible.
Use individual personal hygiene items.
When using the toilet, flush the water twice.
Change underwear and bedding daily. Since radiation is easily removed by washing, the patient’s clothes can be washed along with the clothes of the rest of the family.
Avoid close contact with small children: pick them up and kiss them. You should stay close to children as little as possible.
For three days after discharge (this occurs on the fifth day after taking the isotope), sleep only alone, separately from healthy people. It is allowed to have sexual contact, as well as to be near a pregnant woman, only a week after discharge from the clinic.
If a patient who has recently undergone treatment with radioactive iodine is urgently admitted to the hospital, he is obliged to report this medical personnel, even if the radiation 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 of a short-term nature.

Radioiodine therapy can cause certain complications:

Sialadenitis – inflammatory disease of the salivary glands, characterized by an increase in their volume, compaction and pain. The impetus for the development of the disease is the introduction of a radioactive isotope in the absence of a removed thyroid gland. In a healthy person, thyroid cells would become active in an effort to eliminate the threat and absorb radiation. In the body of the operated person, this function is taken over by the salivary glands. Progression of sialadenitis occurs only when receiving a high (above 80 millicuries - mCi) dose of radiation.
Various reproductive disorders, but such a reaction of the body occurs only as a result of repeated irradiation with a total dosage exceeding 500 mCi.

Alyona:

Several years ago I suffered severe stress, after which I was exposed to terrible diagnosis– toxic diffuse goiter, or Graves' disease. My heart rate was so bad that I couldn't sleep. Due to the constant heat I experienced, I walked around all winter in a T-shirt and a light jacket. My hands were shaking and I was suffering from severe shortness of breath. Despite my good appetite, I lost a lot of weight and felt tired all the time. And - to top it all off - a goiter appeared on the neck. Huge and ugly. I tried a lot medicines, went through sessions of acupuncture and oriental massage. I even contacted psychics. There was no point. In complete despair, I decided to undergo radioiodine therapy. The treatment took place in a Warsaw clinic. The whole procedure took two days. On the first day I took tests and an isotope capture test. In the morning next day A scintigraphy procedure was performed. Having summed up the research results, the doctor prescribed me a dose of radioiodine equal to 25 mCi. The radiotherapy session went very quickly: a capsule was removed from a container with a radioactivity symbol using a plastic tube. I was asked to take a sip of water from a disposable cup and stick out my tongue. After the capsule was on my tongue (I didn’t touch anything with my hands), they gave me water again. After shaking my hand and wishing me health, the doctor let me out of the office. The procedure was completed. I didn't experience any special sensations. The next morning my throat hurt a little. After a couple of hours it went away. The next day my appetite decreased slightly. Ten days later I felt the first signs of improvement. The pulse slowed down, strength began to increase, the goiter began to shrink before our eyes. Eight weeks after radioiodine therapy, my neck became thin and beautiful again. Normalization of analyzes occurred after six weeks. There are no problems with the thyroid gland now, I feel like a completely healthy person.

After reviewing the package medical documents(it takes two to three days to review them), leading experts medical institution decide on the advisability of issuing a quota. As practice shows, the chances of receiving a quota by the end of the year are extremely small, so you should not plan treatment for this period.

If you are refused by one clinic, do not despair. You should call all medical institutions that provide radioiodine therapy. With some persistence, you can achieve a quota.

A completely different situation occurs if the patient is able to pay for his treatment. Unlike patients forced to stand in line to receive free quota and not having the right to choose a medical institution, a person who has paid for a course of radioiodine therapy can undergo it in any clinic he likes.

The cost of radioiodine therapy is determined based on the level of the medical institution, the qualifications of the specialists working there and the dosage of radioactive iodine.

So, for example, the cost of treatment at the Obninsk Radiological Center is as follows:

A patient receiving radioiodine at a dosage of 2 GBq (gigabecquerels) and placed in a single room will pay 83,000 rubles for treatment. Accommodation in a double ward will cost him 73,000 rubles.
If the dosage of radioiodine was 3 GBq, treatment with a stay in a single room will cost 105,000 rubles; in a double room – 95,000 rubles.

The cost of radioiodine therapy at the Arkhangelsk medical center ranges from 128,000 to 180,000 rubles. Treatment in the radiology department of the Moscow scientific center will cost the patient an amount equal to 120,000 rubles.

Of course, all prices given are approximate. It is necessary to clarify information about the cost of treatment in a conversation with the responsible employees of the medical institution.

You can undergo a course of radioactive treatment of the thyroid gland in a number of Russian clinics:

at the Moscow federal state budgetary institution “Russian Scientific Center for Radiology”;
at the Arkhangelsk Northern Medical Clinical Center named after N.A. Semashko";
at the Kazan “Center for Nuclear Medicine”;
in Obninsk "Medical Radiological scientific center them. A.F. Tsyba";
in the radiology department of the City Clinical Hospital No. 13, located in Nizhny Novgorod;
in the radiology department of the Omsk Regional Clinical Hospital;
at the Krasnoyarsk “Center for Nuclear Medicine of the Siberian Clinical Center of the Federal Medical and Biological Agency of Russia.”

Radioactive iodine is used in endocrinology to treat the thyroid gland. It is capable of destroying thyrocytes and atypical cells of malignant neoplasms of the endocrine organ.

Treatment with radioactive iodine is a successful alternative to traditional treatment methods. The advantage of the procedure is the elimination of radiation exposure to the body as a whole.

Radioactive iodine I-131 is prescribed for the treatment of the following gland diseases:

Hyperthyroidism caused by increased secretion of hormones - in this case, radioactive iodine neutralizes or suppresses the activity of hypertrophied areas of the organ, selectively destroying those areas that have thyrotoxic properties;
Diffuse toxic goiter;
A malignant process in the gland is follicular or papillary cancer.

Sometimes after treatment the following unpleasant complications appear:

a sore throat;
nausea, vomiting;
neck discomfort;
increased fatigue;
sudden rush of blood;
an inflammatory process in the salivary glands against the background of which the patient complains of severe soreness of the cheeks and
dry mouth;
pathologically high growth or, on the contrary, a drop in hormones in the blood.

Contraindication to radioiodine therapy

is pregnancy.

Women expecting a child have an increased risk of developing consequences that can be dangerous for the fetus, causing developmental defects. During lactation, women should stop breastfeeding their baby.

With this treatment there is a high chance of getting rid of hyperthyroidism, diffuse goiter and oncological pathology without surgical intervention, and there are many advantages to this:

there is no need for anesthesia,
there will be no pain,
there will be no postoperative scar left.

It is enough just to take the required dosage of radioactive iodine, and the force of radiation will not be distributed to the entire body of the patient.

The effectiveness of treatment can be judged 2 months after the start of the procedure, but there is evidence of faster results.

The cure of hyperthyroidism and recovery will be indicated by a physiological decrease in the function of the gland - the amount of hormones produced by it will be significantly reduced, sometimes even to another opposite state - hypothyroidism.

One month before the scheduled procedure

necessary complete failure from iodine and hormone-containing drugs.

One week before the procedure, a medication waiver applies to all medications used to treat hyperthyroidism.

It is important not to eat or drink any liquid for about 2 hours before taking radioactive iodine.

Patients of childbearing age should undergo a pregnancy test to avoid unnecessary risk.

Immediately before the procedure, a diagnosis is performed to demonstrate how the thyroid gland absorbs iodine.

Based on the data obtained, the doctor selects the required dosage of I-131 for the patient on an individual basis. If a malignant process is detected in an endocrine organ, a total resection of the gland is performed.

The tactics are simple: the patient is given several tablets with radioactive iodine, which he needs to take with clean water.

The active substance of the drug physiologically enters the gland tissue and begins its action.

As a rule, iodine is localized almost completely in the thyroid tissue of the endocrine organ, including cancer cells, beginning its destructive influence.

This mechanism is based on the radioactive radiation of the drug, the depth of action of which remains within 2 mm - it turns out that the isotopes act exclusively in the tissues of the thyroid gland.

If necessary, the drug is offered to the patient in liquid form, while its therapeutic characteristics will remain intact.

For the patient, the use of radioactive treatment is undoubtedly beneficial. But for those who come into contact with it, it is rather harm and an increased risk.

Therefore, for the duration of treatment, the patient is placed in a separate room, or in a room where there are already patients receiving similar therapy.

Medical workers will appear in the ward only to perform manipulations in special protective clothing.

Any patient visits and contacts

contact with the outside world outside the hospital walls is prohibited during treatment.

Immediately after internal use of radioactive iodine, it is recommended to adhere to the following rules:

exclude contact with strangers;
do not eat food for at least two hours after the procedure;
do not limit fluid intake;
wash your hands with soap more often;
after the toilet, flush twice;
Rinse your toothbrush with plenty of running water after each use.

After a month you need to visit a doctor.

The fact is that radioactive iodine can cause hypothyroidism - insufficient gland function.

And this pathology can manifest itself at any moment. Therefore, the state of the endocrine organ must be monitored over time until the amount of hormones in the blood becomes stable.

exclude sex life and kisses for at least one week;
use reliable contraceptives for a year;
stop breastfeeding if it was practiced before treatment with radioactive iodine - then the child should be fed artificially;
get rid of personal belongings that were used in the hospital, if this is not possible, then put them in a plastic bag and do not touch them for 6 weeks;
Personal hygiene items should be used separately from other family members.

The elimination and half-life of radioactive iodine is 8 days.

That is, there can be no talk of any long-term pollution of the surrounding space. The drug leaves the human body in urine.

If the treatment was chosen correctly and the patient followed all the necessary recommendations, then the probability of recovery is close to 98%.

No deaths have been recorded during the entire existence of radioactive iodine therapy.

Thus, this type of treatment has no alternatives and is a fast and effective method of treating pathologies of the endocrine system, including cancer.

Treatment of the thyroid gland with radioactive iodine is used in practice by endocrinologists quite often. Its popularity lies in the fact that it has a destructive effect on thyrocytes and atypical cells of malignant thyroid tumors.

Radioiodine therapy is considered a successful alternative traditional methods. The main advantage of this procedure is that it does not expose the human body to radiation.

Description of the method

Treatment of the thyroid gland is carried out using iodine, which has radioactive properties, which in medicine is also called radioiodine and iodine - 131. It is one of 37 isotopes of iodine - 126, which almost everyone has in their home medicine cabinet.

The half-life of radioiodine is eight days. Therefore, it has the ability to disintegrate independently in the patient’s body. As a result, xenon and radiation of 2 types are formed - gamma and beta.

Having good permeability, gamma particles easily penetrate human tissue. To register them, special equipment is used. Gamma radiation does not have a therapeutic effect, but thanks to it, it becomes possible to establish the accumulation of a substance. When scanning the body, a specialist can easily find areas of isotope formation.

Such information is necessary when treating patients diagnosed with thyroid cancer. The appearance of luminous foci after radioiodine therapy makes it possible to determine the presence and location of malignant neoplasms.

Important! The main goal of therapy is to completely destroy the affected thyroid cells. The positive effect is visible 2-3 months after the course. If a relapse occurs, it is possible replay course.

Indications and contraindications for

Treatment of the thyroid gland with iodine is possible when the patient has the following pathologies:

The method is also effective in the treatment of nodular toxic goiter and Graves' disease. If you have such diseases surgery replaced with radioiodine. The use of radioiodine therapy is especially necessary for relapses of the thyroid gland that has already undergone surgery.

Since the development of complications in postoperative period is quite large, experts prefer radioiodine therapy. Contraindications to such a procedure include pregnancy and lactation. In the first case, when the fetus is exposed to radioiodine, deviations in its further development cannot be ruled out. If nursing mothers are treated with radioactive iodine, they must stop breastfeeding their baby.

Pros and cons of radioiodine therapy

Iodine 131 used in thyroid therapy has a number of advantages. Among the main ones:

However, despite the positive aspects, treatment of the thyroid gland with iodine also has a number of disadvantages:

In addition, all items and clothing used by the patient during the course must be carefully processed or disposed of.

Preparation for the procedure and features of its implementation

The preparatory stage before taking the isotope must begin 14 days before the start of the course. General recommendations:

It is prohibited to lubricate wounds and apply meshes. In addition, it is important to avoid swimming in sea water and visiting salt caves. If you permanently live near the sea coasts, you need to isolate yourself from the external environment for 5-6 days before radioiodine procedures are performed.
Women of childbearing age are required to take a pregnancy test.
Refusal vitamin complexes, medications and supplements that contain iodine.
Before taking the capsule, a test is done to determine the level of iodine absorption by the thyroid tissues. If the gland is removed by surgery, a sensitivity test is performed on the lymph nodes and lungs to the drug.

Diet features

When preparing to undergo radioiodine therapy, it is necessary, first of all, to follow a special diet, the main task of which is to reduce the level of iodine in the body.

Complete avoidance of the following products:

Allowed to use:

The diet does not imply a complete abstinence from salt. You just need to use it in limited quantities - up to 8 grams per day.

Principle of the procedure

Radioiodine therapy for the thyroid gland is considered sufficient effective procedure. Its distinctive feature is that a small amount of radioactive substance is used, which selectively accumulates in those places where therapeutic intervention is required.

During the session, the patient is given a gelatin capsule containing radioiodine inside. It must be swallowed quickly and washed down with plenty of liquid. In some cases, liquid iodine may be given, after which a thorough rinse is required. oral cavity. In order for the drug to be better absorbed, do not consume food or drinks for 60 minutes. After the capsule enters the body, iodine accumulates in the thyroid tissues. It is excreted through bowel movements, urine, sweat or saliva.

After radioiodine therapy, patients must follow certain rules while they are in a separate box:

go to the toilet carefully, do not splash urine, and after all actions, flush the toilet at least twice;
After brushing your teeth, rinse the brush well under running water;
in case of vomiting, use a plastic bag;
use only disposable tissues;
always close the front door;
flush used paper down the toilet;
use the shower every day;
if there is no stool, inform the medical staff about this fact.

When the patient is completely isolated, visits are strictly prohibited, since healthy individuals may be exposed to gamma and beta particles.

Which method is better: radioiodine treatment or surgery?

There is still no single answer to this question. Endocrinologists have conflicting opinions. Some believe that it is better to use a thyroidectomy. This is explained on their part by the patient’s ability to lead a normal life even after surgery.

Proponents of radioiodine therapy are based on the fact that it is better to treat the thyroid gland using this method, since there is no need to administer anesthesia and the laryngeal nerve is not damaged. The main advantage of using radioactive iodine is that the procedure is painless and non-invasive. In addition, possible negative consequences. It is difficult to say for sure which method is better. The decision to choose is made only by the doctor individually for each case.

Important! If there are no contraindications to radioiodine therapy, then most likely the specialist will recommend this particular method of treatment. If surgery is advisable, it is better to listen to the doctor’s opinion and agree to surgery.

After completing a course of radioiodine therapy, the patient must follow certain rules:

Also, all patients will be required to undergo examinations by an endocrinologist twice a year throughout their lives and constantly take Thyroxine. All other restrictions are short-term.

The use of radioiodine therapy may provoke some Negative consequences. First of all, the development of sialadenitis is possible - this is a pathology of the salivary glands inflammatory in nature. The cause of the manifestation is the ingestion of a radioactive isotope into the body in the absence of a removed thyroid gland. In addition, reproductive function disorders are also possible. However, such a reaction occurs only in the case of repeated irradiation, the total dosage of which exceeds 500 mCi.

With the right treatment and compliance with all necessary instructions from the attending physician, the probability of recovery is 98 percent.

During the entire period of use of radioiodine therapy, not a single death was recorded. This method is considered one of the fastest and most effective in treating the thyroid gland.

Yakutina Svetlana

Expert of the ProSosudi.ru project