Where is the thyroid gland treated with radioactive iodine. Preparatory stage before radioactive iodine treatment

Radioiodine therapy consists in the internal administration of drugs containing radioactive iodine - isotope 131. The doses of drugs are minimal, so the body does not suffer from radiation and does not cause negative consequences.

The drug, getting into the body, begins to disintegrate, as a result, beta and gamma radiation are released. Beta particles do not act on the thyroid gland and are excreted very quickly. And gamma particles are stronger and are able to penetrate into any organs of the patient. Based on the emitted gamma waves using special device it is possible to determine the distribution of iodine throughout the body.

Preparations for radioiodine therapy are divided into two types:

Gelatin capsules.
liquid solution. Allows you to adjust the dosage, but negatively affects the condition of the teeth and oral mucosa.

radioactive iodine absorb only cells of the thyroid tissue, predominantly of the central location. At the site of the dead cells, fibrotic changes are observed, but the remaining peripheral cells are able to secrete a small amount of hormones. Radioactive iodine also has a detrimental effect on metastases, including distant localization.

Radioactive iodine treatment for thyroid cancer

Treatment of thyroid cancer with radioactive iodine is carried out in specialized clinics, since the patient needs to be protected from contact for several days.

How is thyroid radioactive iodine treated?

First, the patient is prescribed an examination, according to the results of which an individual dosage of radioactive iodine is selected.
If necessary, carry out special training aimed at improving the absorption of iodine.
The patient is given a liquid preparation or capsules. The medicine should be washed down with plenty of water.

Usually, treatment and diagnostic rooms are located in close proximity to the wards, but if they are on another floor, then patients who have received a dose of radiation can only use specially designated elevators and stairs.

During treatment, the patient must remain in strict isolation. In each individual case, this period varies from 3 to 21 days, depending on the dosage of the drug. The average hospital stay is 3 to 8 days.

After treatment, the patient is regularly examined to determine whether all thyroid tissue and metastases have been destroyed. Fully rate therapeutic effect possible 3-4 months after treatment.

Indications and contraindications for treatment

Radioactive iodine in medical purposes used under strict conditions. Before starting therapy, the patient must undergo a complete examination to confirm the diagnosis.

Indications for use:

malignant tumors;
secondary tumors on the background of cancer;
severe forms of thyrotoxicosis;
recurrence of thyrotoxicosis;
inoperable tumors.

The oncologist, referring the patient for treatment, must make sure that he has no contraindications:

renal and liver failure;
multinodular goiter, with a volume of more than 40 ml;
hypersensitivity to the drug;
thyroiditis that occurs after pregnancy;
acute stage of gastrointestinal ulcers;
diabetes mellitus of the decompensated stage;
behavioral disorders, mental illness;
aplastic anemia;
violation of hematopoiesis in the cat's brain;
HIV, immunodeficiency states.

Radioiodine therapy is contraindicated in childhood, since the thyroid gland of children absorbs an excess dose of radiation, which leads to serious complications. For the same reason, radioactive iodine treatment of the thyroid gland is contraindicated in pregnant and lactating women.

Attention! During pregnancy, radioactive iodine preparations penetrate the thyroid gland of the fetus, causing a threat of radioactive contamination.

What are the pros and cons of radioactive iodine treatment?

Treatment with radioactive iodine has its advantages and disadvantages. They should be considered before prescribing therapy.

Advantages of radioiodine therapy:

can be used for small tumors, avoiding surgical intervention;
does not leave scars and scars on the patient's body;
there is no need for anesthesia;
radioiodine therapy allows you to get rid of even distant metastases, while affecting only cancer cells;
no damage parathyroid glands and cervical nerve.

Disadvantages:

a patient who has taken a preparation of the iodine isotope 131 emits radioactive radiation, therefore it is dangerous to others;
the need for isolation for a period of 3 to 21 days, depending on the dose of drugs;
all things that the patient has come into contact with are subject to destruction or special processing;
there are side effects that reduce the quality of life of the patient;
loss of thyroid function and the need for hormone therapy after treatment.

The gonads are exposed to a certain dose of radiation, so pregnancy can only be planned a year after therapy. The possibility of pregnancy should be consulted with a doctor, since the recovery of the body directly depends on the amount of the drug taken.

Operation or radioactive iodine, what to choose?

Very often the question arises - what to choose surgery or radioiodine therapy? Most often, doubts arise with thyrotoxic goiter, since most patients want to get rid of the problem without surgical intervention.

But with malignant tumors is a necessity. Radioactive iodine is prescribed after surgical removal of a malignant neoplasm. A complex approach to treatment allows you to completely destroy the cells of the thyroid tissue of the thyroid gland remaining after the operation.

Preparation for therapy

Treatment with radioactive iodine of the thyroid gland requires special preparation. The main condition is the abolition of L-thyroxine and iodine-containing drugs 4-6 weeks before the start of therapy.

After the abolition of hormone therapy, it rises in the body, which contributes to a better capture of iodine isotopes by the thyroid gland. The best effect is achieved if the concentration of thyroid-stimulating hormone does not fall below 30 mU/L.

In some cases, two days before the start of radioiodine therapy, intravenous administration Thyrogen containing recombinant human hormone TSH. A diet containing minimal amount iodine, should begin two weeks before the start of therapy.

Required examinations:

Tests for thyroid hormones, TSH, calcitonin.
Analyzes for calcium and phosphorus.
Ultrasound examination of the neck.
Scintigraphy.
Radiography of the lungs.
Checking the function of external respiration.

If a woman plans to treat her thyroid gland with radioactive iodine, then she needs to make sure that she is not pregnant.

Possible diets and nutrition correction during radioiodine therapy

An oncologist prescribing radioactive iodine treatment should warn him of the importance of an iodine-free diet. A low iodine content in the diet, as well as the abolition of thyroid-stimulating hormones, is required for the preparation of the thyroid gland.

What should be excluded from the diet?

Seaweed, shrimp, fish and other seafood.
Sea and iodized salt.
Butter.
Smoked meats, marinades.
Sausages.
Milk, kefir, cheese.
Egg yolk.
Products containing agar-agar.
Food containing red and orange dye.
Soy products.
Greens, green vegetables.
Legumes.
Dried fruits.

Attention! You should study the composition of ready-made meals, refuse fast food and eating in public places - you need to cook only at home from permitted products.

What can you eat?

Pasta that does not contain eggs.
White and brown rice.
One serving of cereal per day.
No more than 150 g of meat per day.
2-3 servings river fish in Week.
Jelly based on gelatin.
Egg white.
Bitter chocolate.

From vegetables, you can choose zucchini, carrots, potatoes, cucumbers, beets and pumpkins, but in limited quantities. On the day you can eat 2 fruits to choose from: apples, pineapples, peaches, melons. It is permissible to drink natural juices, compotes and fruit drinks.

Treatment after thyroidectomy

Radioactive iodine is performed after a thyroidectomy. This sequence allows you to completely destroy the residual thyroid tissue, regional and distant metastases.

Metastases of thyroid carcinomas pose a serious threat to the patient. The formation of secondary tumors significantly reduces life expectancy.

Radioiodine therapy after removal of the organ can improve survival rates in differentiated cancers.

It is recommended to start cancer treatment with radioactive iodine one month after partial or complete removal of the organ. It has been proven that if radioiodine therapy is performed early after surgery, the likelihood of recurrence and the formation of secondary tumors decreases.

During the course of therapy, precautions are required to protect the people around.

What rules must be followed?

It is forbidden to leave the room.
Empty the tank twice after using the toilet.
Take a shower 1-2 times a day.
Hygiene items (brush, comb, razor) rinse with running water.
Avoid getting saliva, vomit and feces on the floor.
It is impossible to feed animals and birds with leftover food - everything is disposed of in special containers.
Hygiene items and clothes remain in the room after discharge for disposal.
Drink enough pure water.

Attention! Within 1-1.5 months after treatment, it is necessary to avoid contact with pregnant women, children and people with reduced immunity - small doses of radiation continue to be released with sweat and air flow.

After discharge from the hospital, you can start working in 3-4 weeks. But for another two months it is necessary to limit physical exercise, as well as refuse to visit the pool and public baths.

Consequences of radioactive iodine treatment

Radioiodine therapy can cause complications.

The first effects of radioactive iodine treatment of the thyroid gland appear within 7-10 days after taking the medication, these include:

burning and sore throat;
nausea, vomiting;
stool disorders;
pain in the abdomen;
dry mouth, thirst;
exacerbation of chronic pathologies;
slight increase in temperature;
severe weakness;
inflammation salivary glands;
allergic manifestations.

Long-term side effects for radioiodine therapy are not typical. Iodine preparations are quickly excreted from the body, without exerting a carcinogenic effect. Even if a slight effect of radiation is exerted on the sex glands, then after 1-1.5 years you can begin to plan a pregnancy.

Where is radioiodine therapy treated in Russia, and what is the cost of therapy?

There are few clinics in Russia where cancer treatment with radioactive iodine is practiced. This is explained by the fact that the radiotherapy department must be specially equipped, and this is quite expensive. For this reason, this type of therapy is not available in most clinics.

Where do they undergo therapy in Russia?

Centers for Nuclear Medicine in Kazan and Krasnoyarsk.
FGBU "RNTSRR" Moscow.
Arkhangelsk Medical Center named after N.A. Semashko.
"MRNC" them. A.F. Tsyba, Obninsk.
City hospital No. 13, Nizhny Novgorod.
Omsk regional hospital.

On average, the price for a course varies from 70,000 to 150,000 rubles. The cost of therapy depends on the dosage of the drug, living conditions and the length of stay in the hospital. The final prices must be obtained directly from the clinic.

Attention! You can get a quota under the CHI policy - get treatment for free. To do this, you need to build a package required documents and wait for the decision of the medical commission.

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

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

Radioactive iodine is used when thyroid treatment is needed to prevent further development diseases.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

During such a period should not happen additional problems with health. As soon as the period is over, the doctor will allow the patient to switch to the usual diet.

While following the diet, you should follow the rules:

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

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

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

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

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

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

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

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

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

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

In the treatment of thyroid pathologies, radioactive iodine can be used. This isotope has its own dangerous properties therefore, the procedure for its introduction into the body should be carried out exclusively under the supervision of a highly qualified doctor.

Radioactive iodine - treatment of the thyroid gland

The isotope procedure has the following advantages:

is absent rehabilitation period;
there are no scars and other aesthetic defects on the skin;
no anesthetics are used during the procedure.

However, radioactive iodine treatment has its drawbacks:

The accumulation of the isotope is observed not only in the thyroid gland, but also in other tissues of the body, including the ovaries and prostate. For this reason, patients should be carefully protected for the next six months after the procedure. In addition, the introduction of the isotope disrupts the production of hormones, which can negatively affect the development of the fetus. Women childbearing age have to postpone the conception of a child for 2 years.
Due to the narrowing of the tear ducts and changes in the functioning of the salivary glands, malfunctions in the functioning of these body systems can be observed.

Radioactive (more often I-131) iodine is prescribed in the following cases:

neoplasms on the thyroid gland;
thyrotoxicosis;
operations on the thyroid gland;
development risk postoperative complications.

Treatment of thyrotoxicosis with radioactive iodine

This therapy gives good results. In order for the treatment of hyperthyroidism with radioactive iodine to be effective, the dose of I-131 absorbed by the gland tissues should be 30-40 g. This amount of the isotope can enter the body at once or fractionally (in 2-3 doses). After therapy, hypothyroidism may occur. In this case, patients are prescribed Levothyroxine.

According to statistics, in those who are diagnosed, after treatment with an isotope, the disease recurs after 3-6 months. Such patients are prescribed repeated therapy with radioactive iodine. The use of I-131 for more than 3 courses in the treatment of thyrotoxicosis has not been recorded. In rare cases, radioactive iodine therapy fails in patients. This is observed in the resistance of thyrotoxicosis to the isotope.

Treatment of thyroid cancer with radioactive iodine

The isotope is prescribed only for those patients who have been diagnosed with cancer as a result of surgical intervention. More often, such therapy is carried out at a high risk of recurrence of follicular or papillary cancer. Treatment of the thyroid gland with radioactive iodine is carried out in the presence of residual tissues that absorb and accumulate I-131. Before this, a scintigraphy is performed.

The isotope is prescribed to patients in the following dosage:

during therapy - 3.7 GBq;
in the case when metastases affected the lymph nodes - 5.55 GBq;
with damage to bone tissue or lungs - 7.4 GBq.

Radioactive iodine after thyroidectomy

I-131 is used to detect metastases. 1-1.5 months after surgery, a scintigraphy using radioactive iodine is performed. This diagnostic method is considered more effective. X-ray - less reliable way identify metastases. At a positive result radioactive iodine therapy is prescribed. Such treatment is aimed at the destruction of lesions.

Preparation for radioiodine therapy

The patient's condition after treatment largely depends on compliance with the doctor's instructions. Not the last role here is given to how well the preparation for the procedure was carried out. It includes the following rules:

Make sure you are not pregnant.
If there infant, transfer it to artificial feeding.
Tell your doctor about all medications you are taking. 2-3 days before radioiodine therapy, their consumption should be stopped.
Stick to special diet.
Do not treat wounds and cuts with iodine.
Bathing in salt water and breathing sea air is prohibited. A week before the procedure, walks on the coast should be abandoned.

In addition, a couple of days before radioiodine therapy, the doctor will conduct a test to determine the intensity of absorption of I-131 by the patient's body. Immediately before the radioactive iodine therapy of the thyroid gland is performed, a TSH test should be taken in the morning. Also, 6 hours before the procedure, you should stop eating, and drinking water - 2 hours before.

Diet before radioactive iodine

Such a nutrition system is prescribed 2 weeks before the procedure. It ends 24 hours after therapy. An iodine-free diet before radioactive iodine treatment includes a ban on the following foods:

eggs and food containing them;
seafood;
red, variegated and lima beans;
chocolate and products where it is present;
cheese, cream, ice cream and other milk;
food that has been added to cooking iodized salt;
soy products.

Radioactive iodine - how is the procedure performed

I-131 is taken orally: the patient swallows gelatin-coated capsules containing the isotope. These pills are odorless and tasteless. They must be swallowed with two glasses of water (juice, soda and other drinks are unacceptable). Do not chew these capsules! In some cases, the treatment of toxic goiter with radioactive iodine is carried out using a chemical agent in liquid form. After taking such iodine, the patient needs to rinse his mouth well. In the next hour after the procedure, eating and drinking are prohibited.

For the patient, radioactive iodine is of great benefit - it helps to cope with the disease. For visitors to the patient and other persons in contact with him, the isotope is extremely dangerous. The half-life of this chemical element is 8 days. However, even after discharge from the hospital, in order to protect others, the patient is recommended:

For another week, forget about kisses and intimate relationships.
Destroy personal items used in the hospital (or put them in a heavy plastic bag for 6-8 weeks).
Safely protected.
Keep personal hygiene items separate from other family members.

Treatment with radioactive iodine of the thyroid gland - consequences

Because of individual characteristics the body may experience complications after treatment. Radioactive iodine creates the following consequences for the body:

difficulty swallowing;
swelling in the neck;
nausea;
lump in the throat;
strong thirst;
distortion of taste perception;
vomit.

Side effects of radioactive iodine treatment

Although this method of therapy is considered safe for the patient, it also has its downsides. Irradiation with radioactive iodine brings with it the following problems:

vision deteriorates;
exacerbated existing chronic ailments;
radioactive iodine contributes to weight gain;
observed muscle pain and increased fatigue;
the quality of blood worsens (the content of platelets and leukocytes decreases);
against the background of a decrease in hormone production, depression and other mental disorders develop;
in men, the number is reduced active sperm(cases of infertility have been recorded);
increased risk of development.

Which is better - radioactive iodine or surgery?

There is no single answer, because each case is individual. Only a doctor can determine what will be most effective for this patient- radioactive iodine or surgery. Before choosing a method of dealing with thyroid pathology, he will take into account various factors: the age of the patient, the presence of chronic diseases, the degree of damage to the disease and so on. The doctor will definitely tell the patient about the features of the chosen method and describe the consequences after radioactive iodine.

Treatment of the thyroid gland with radioactive iodine is often the only way to avoid radical operation and eliminate the existing disease. Radioiodine therapy is often given to people with some forms of differentiated cancer. In this case, such therapy can achieve best effect and eliminate the neoplasm without. The isotope I-131 was created artificially. It allows you to expose only this gland to radiation, without affecting other organs.

Indications and contraindications

Thyroid tissues accumulate iodine, so only they are destroyed. The effect is achieved 2-3 months after the start of therapy. Result at correct execution The procedure for treating the thyroid gland with radioactive iodine is similar to surgery. The effect is achieved in a less traumatic way than during surgery. Indications for irradiation of the thyroid gland:

different types .

Similar treatment proved effective at . The use of this method of therapy is justified in some variants of the thyroid gland. In these pathological conditions, radioiodine therapy can achieve best result than during surgery. The use of this method of therapy almost eliminates the risk of relapse, often observed after surgery.

The use of radioactive iodine allows you to achieve a better result than with surgery.

Treatment of thyroid cancer with radioactive iodine is also justified. This isotope not only accumulates in the tissues of the affected organ, contributing to the destruction of those degenerated into areas, but also shows high efficiency against metastases located in distant organs. The use of radioactive iodine is justified in case of recurrence of thyroid pathology, which was previously treated with surgical methods.

This procedure also has contraindications. Such treatment is not prescribed for pregnant women, since exposure to iodine can cause miscarriage or the appearance of malformations in the child. Radioiodine therapy for thyroid diseases is contraindicated during lactation. If the need for thyroid treatment is high, women need to stop breastfeeding for a long time in the future.

Pros and cons of the procedure

Significant advantages of using this method include:

no need for anesthesia;
short rehabilitation period;
exclusion of scars after the procedure;
the possibility of eliminating residual effects with drugs;
safety for other organs and systems;
low risk of relapse.

A patient who is offered to undergo radioactive iodine treatment for a particular thyroid disease should also be aware of the disadvantages of such therapy. In small quantities, the isotope accumulates in the genitals, as well as in the mammary glands. After the procedure on the thyroid gland, women are advised to protect themselves from pregnancy for at least 6 months to allow the body to remove the remaining iodine from the thyroid gland.

As after the removal of the thyroid gland, in patients treated with the I-131 isotope, it develops in the future. This condition requires lifelong hormone replacement therapy. Rarely observed disadvantages of using this method include:

high probability of developing autoimmune ophthalmopathy;
the possibility of narrowing the salivary and lacrimal glands under the action of the isotope;
weight gain;
exacerbation of chronic diseases;
complete loss of all gland tissues.

Radioiodine therapy creates the prerequisites for the development of bowel cancer. The disadvantages of this method of therapy include the need to isolate the patient after the procedure for at least 3 days. This is due to an increase in background radiation. After treatment, all things that were in the ward and were in direct contact with the patient should be subjected to special treatment or disposed of.

Preparing for Thyroid Radiotherapy

In order for the procedure to bring the maximum effect, the patient must begin to follow all recommendations in advance. Preparation for thyroid treatment with radioactive iodine, if possible general state patient, begins 1 month before the procedure. Sometimes 14 days is enough.
During this period, the patient must stop using any iodine-containing drugs, including those used to treat hyperthyroidism.

Iodine is unacceptable even as an antiseptic.

In preparation for radioactive iodine treatment, women of childbearing age are screened to rule out pregnancy. In addition, often tests are needed to clarify the level in the blood.

Approximately 2 hours before the procedure, it is necessary to exclude the use of any food and water. Just before using radioactive iodine, a test is performed to determine how the thyroid gland absorbs iodine. The results of this study determine the dosage of the isotope to be used during treatment.

Diet before therapy

The most important moment in preparing for the procedure is to refuse. The patient is prescribed a special diet, which allows you to minimize the content of this substance in the body. You must adhere to it for at least 2 weeks before the procedure.
This will increase the effectiveness of radioactive iodine treatment and reduce the risk of complications. The appointment of a diet requires an individual approach, so the patient must strictly follow the recommendations of the attending endocrinologist. Since nutrition should be as depleted as possible in iodine, the following should be excluded from the diet:

seafood;
all dairy;
fruit and meat preserves;
bakery products;
dishes dyed brown and red;
many types of vegetables.

During the preparation for the thyroid irradiation procedure, it is necessary to follow the doctor's recommendations regarding the choice of products as much as possible. Despite the limitations, it is important that the diet is complete and includes the required amount of proteins, fats, carbohydrates and other substances.

The iodine-free diet menu may include the following foods:

peanuts without additives;
coconuts;
berry and fruit jams and jellies;
apples;
citrus;
pineapples;
peaches;
vegetable oils;
chicken;
turkey;
boiled vegetables;
pasta;
cereal porridge;
beef;
lamb meat;
veal.

It is necessary to take food in small portions 4-5 times a day. This will maximize the use of iodine entering the body, which is contained in small quantities even in permitted products.

Carrying out the procedure

In most cases, thyroid treatment involves single dose radioactive isotope, but sometimes a short course of such therapy is required. After careful preparation, the patient is given several tablets containing prepared iodine. They need to be asked clean water. The active substance, which is present in the drug, is quickly absorbed into the blood in a physiological way and absorbed by the thyroid gland.

The depth of tissue damage by radioactive radiation does not exceed 2 mm, so the surrounding structures are not damaged. From such exposure, only thyroid cells that accumulate iodine die.

The patient is placed in a separate room where other people undergoing similar therapy are kept. Medical workers should visit such patients only in special suits and only when urgent need carrying out certain manipulations. Any contact with the outside world for at least 3 days should be excluded. After the procedure, you must refrain from eating for 2 hours.

Water can be drunk in any quantity. This will help to quickly remove the decay products of the isotope.

It is advisable to wash your hands frequently with soap and rinse your toothbrush thoroughly with plenty of running water. Specific rehabilitation is not required, but after the procedure, it is necessary to consult an endocrinologist to prescribe replacement therapy, since you have to drink after such therapy throughout your life.

Consequences of radioiodine therapy

In most cases, after the procedure, the patient's condition gradually stabilizes and, despite temporary restrictions, he quickly returns to normal life. The therapeutic effect accumulates over 2-3 months. In rare cases of relapse, a second course of thyroid isotope treatment may be indicated. Complications after radioactive iodine therapy are most common in people who have had to undergo radiation several times.

The most common consequence is sialadenitis, that is, inflammation of the salivary glands.

This is pathological condition accompanied by their increase in size and pronounced compaction. A similar complication is present with high-dose irradiation of the thyroid gland, reaching values of more than 80 mCi. High risk of disruption reproductive system against the background of the accumulation of small doses of radioactive iodine in the genitals. This unfavorable phenomenon is observed during repeated irradiations, the total dose of which exceeds 500 mCi.

Price

All citizens Russian Federation who have a compulsory medical insurance policy, if necessary, undergo treatment according to the received free quota. To do this, you need to contact the hospital that has a radiosurgery department to clarify the possible admission of the patient.

For people who are able to pay for their own treatment, the situation is somewhat different. They can independently choose the clinic they like for the treatment of thyroid pathologies. The price of the procedure can vary from 73 to 180 thousand rubles, depending on the equipment of the clinic and the conditions for providing such a service.

Thyroid gland treatment with radioactive iodine I131 1.1

After radioiodine therapy: results of treatment

Treatment of hyperthyroidism (thyrotoxicosis): radioactive iodine, drugs, surgery

Treatment with radioactive iodine. When is it applied? Risks?

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

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

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

The concept of the method

In radioiodine therapy, radioactive iodine is used (in the medical literature it can be referred to as iodine-131, radioiodine, I-131) - one of the thirty-seven isotopes we all know of iodine-126, which is available in almost every first-aid kit.

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

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

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

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

This information 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 radioactive iodine treatment is the complete destruction of the tissues of the affected thyroid gland.

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

Indications and contraindications

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

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

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

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

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

An absolute contraindication to the appointment of radioid therapy is:

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

Pros and cons of the procedure

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

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

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

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

Which is better, surgery or radioactive iodine?

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

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

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

Training

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

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

Diet before therapy

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

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

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

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

Patients undergoing radioiodine therapy should completely abstain from:

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

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

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

Treatment with radioactive iodine of the thyroid gland

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

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

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

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

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

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

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

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

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

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

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

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

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

Patients treated with radioactive iodine must:

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

Effects

Radioiodine therapy can cause certain complications:

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

Reviews

A few years ago, I suffered a lot of stress, after which I was exposed to terrible diagnosis- toxic diffuse goiter, or Graves' disease. The palpitation was such that I could not sleep. Because of the constant heat, I walked around in a T-shirt and a light jacket all winter long. Hands were shaking, severe shortness of breath tormented. In spite of a 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 of drugs, went through sessions of acupuncture and oriental massage. She even turned to psychics. There was no point. In complete desperation, I decided on radioiodine therapy. The treatment took place in a Warsaw clinic. The whole procedure took two days. On the first day I passed the tests and the isotope capture test. In the morning next day scintigraphy was performed. Summing up the results of the studies, the doctor prescribed me a dose of radioiodine equal to 25 mCi. The radiotherapy session went very quickly: a capsule was removed from the container with the 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 did not touch anything with my hands), they gave me water again. After shaking my hand and wishing me good health, the doctor let me out of the office. The procedure has been completed. I didn't experience any special feelings. The next morning, my throat was a little sore. It passed after a couple of hours. The next day, my appetite decreased slightly. Ten days later I felt the first signs of improvement in well-being. The pulse slowed down, strength began to arrive, the goiter began to decrease just before our eyes. Eight weeks after radioiodine therapy, the neck was again thin and beautiful. Normalization of analyzes occurred after six weeks. There are no problems with the thyroid gland now, I feel like a completely healthy person.

Price

Citizens of the Russian Federation who have a compulsory medical insurance policy and need treatment with radioactive iodine are entitled to receive free quota. First you need to contact (using e-mail or by phone) one of the medical institutions with a radiology department and find out if they can accept a particular patient for treatment.

Having familiarized themselves with the package of medical documents (it takes two or three days to consider them), the leading specialists of the medical institution decide on the appropriateness of issuing a quota. As practice shows, the chances of getting a quota by the end of the year are extremely small, so you should not plan treatment for this period.

Having received a refusal in one clinic, do not despair. All medical institutions that provide radioiodine therapy should be called. With some perseverance, you can achieve a quota.

A completely different situation is observed if the patient is able to pay for his treatment. Unlike patients who are forced to stand in line for a free quota and do not have the right to choose a medical institution, a person who has paid for a course of radioiodine therapy can undergo it at 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 in it and the dosage of radioactive iodine.

So, for example, the cost of treatment in 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 room will cost him 73,000 rubles. If the dosage of radioiodine was 3 GBq, treatment with a stay in a single room would cost 105,000 rubles; in a double room - 95,000 rubles.

The cost of radioiodine therapy medical center the city of Arkhangelsk fluctuates between 128,000 - 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 quoted are approximate. It is necessary to clarify information about the cost of treatment in a conversation with the responsible employees of the medical institution.

Where is radioiodine therapy treated in Russia?

Pass the course radioactive treatment thyroid gland can be used in a number of Russian clinics:

at the Moscow Federal State budget institution"Russian Scientific Center for Roentgen Radiology"; in the Arkhangelsk "Northern Medical Clinical Center named after N.A. Semashko"; in the Kazan "Center for Nuclear Medicine"; Obninsk "Medical Radiological Research Center named after A.I. A.F. Tsyba"; in the radiology department of the City Clinical Hospital No. 13, located in Nizhny Novgorod; in the radiological department of the Omsk "Regional clinical hospital»; in the Krasnoyarsk "Center for Nuclear Medicine of the Siberian clinical center FMBA of Russia.

All chemical elements form isotopes with unstable nuclei, which emit α-particles, β-particles or γ-rays during their half-life. Iodine has 37 types of nuclei with the same charge, but differing in the number of neutrons that determine the mass of the nucleus and the atom. The charge of all isotopes of iodine (I) is 53. When they mean an isotope with a certain number of neutrons, write this number next to the symbol, through a dash. AT medical practice use I-124, I-131, I-123. The normal isotope of iodine (not radioactive) is I-127.

The number of neutrons serves as an indicator for various diagnostic and medical procedures. Radioiodine therapy is based on the varying half-lives of the radioactive isotopes of iodine. For example, an element with 123 neutrons decays in 13 hours, with 124 - in 4 days, and I-131 will have a radioactive effect after 8 days. More often, I-131 is used, during the decay of which γ-rays, inert xenon and β-particles are formed.

The effect of radioactive iodine in the treatment

Iodine therapy is prescribed after the removal of the thyroid gland completely. With partial removal or conservative treatment this method is useless. The follicles of the thyroid gland receive iodides from the tissue fluid that surrounds them. Iodides enter the tissue fluid by diffusion or by active transport from the blood. During iodine starvation, secretory cells begin to actively capture radioactive iodine, and degenerate cancer cells do this much more intensively.

β-particles, released during half-life, kill cancer cells. The striking ability of β-particles acts at a distance of 600 - 2000 nm, which is quite enough to destroy only the cellular elements of malignant cells, and not neighboring tissues.

The main goal of radioiodine therapy is the final removal of all remnants of the thyroid gland, because even the most skillful operation leaves behind these remnants. Moreover, in the practice of surgeons, it has already become customary to leave several gland cells around the parathyroid glands for their normal operation, as well as around the recurrent nerve that innervates the vocal cords. The destruction of the iodine isotope occurs not only in the residual tissues of the thyroid gland, but also metastasis in cancerous tumors, which makes it easier to monitor the concentration of thyroglobulin.

γ-rays do not have a therapeutic effect, but they are successfully used in the diagnosis of diseases. The γ-camera built into the scanner helps to determine the localization of radioactive iodine, which serves as a signal for the recognition of cancerous metastases. The accumulation of the isotope occurs on the surface of the front of the neck (in place of the former thyroid gland), in the salivary glands, along the entire length digestive system, in bladder. Few, but still there are iodine uptake receptors in the mammary glands. Scanning reveals metastases in trimmed and nearby organs. Most often they are found in the cervical lymph nodes, bones, lungs and tissues of the mediastinum.

Treatment prescriptions for radioactive isotopes

Radioiodine therapy is indicated for use in two cases:

If the state of a hypertrophied gland is detected in the form of a toxic goiter (nodular or diffuse). The state of diffuse goiter is characterized by the production of thyroid hormones by the entire secretory tissue of the gland. At nodular goiter only the tissue of the nodes secretes hormones. The tasks of introducing radioactive iodine are reduced to the inhibition of the functionality of hypertrophied areas, since the radiation of β-particles destroys precisely those places that are prone to thyrotoxicosis. At the end of the procedure or restored normal function glands, or hypothyroidism develops, which is easily brought back to normal with the use of an analogue of the hormone thyroxine - T4 (L-form). If found malignant neoplasm thyroid gland (papillary or follicular cancer), the surgeon determines the degree of risk. In accordance with this, risk groups are distinguished according to the level of tumor progress and possible distant localization of metastases, as well as the need for radioactive iodine treatment. The low-risk group includes patients with a small tumor, not exceeding 2 cm and located in the outline of the thyroid gland. No metastases were found in neighboring organs and tissues (especially in the lymph nodes). Such patients do not need to inject radioactive iodine. Patients with an average risk have a tumor larger than 2 cm, but not exceeding 3 cm. If an unfavorable prognosis develops and the capsule in the thyroid gland germinates, a dose of radioactive iodine of 30-100 mCi is prescribed. The high-risk group has a pronounced aggressive pattern of cancer growth. There is germination in neighboring tissues and organs, lymph nodes, there may be distant metastases. Such patients require treatment with a radioactive isotope greater than 100 millicuries.

Radioiodine Administration Procedure

The radioactive isotope of iodine (I-131) is synthesized artificially. It is taken in the form of gelatin capsules (liquid) orally. Capsules or liquid are odorless and tasteless, swallowed only with a glass of water. After taking the liquid, it is recommended to immediately rinse your mouth with water and swallow it without spitting it out.

In the presence of dentures, it is better to remove them for a while before using liquid iodine.

You can’t eat for two hours, you can (even need to) take plentiful drink water or juice. Iodine-131, not absorbed by the thyroid follicles, is excreted in the urine, so urination should occur every hour with the control of the content of the isotope in the urine. Medicines for the thyroid gland are taken no earlier than 2 days later. It is better if the patient's contacts with other people at this time are strictly limited.

Before the procedure, the doctor must analyze the medications taken and stop them at different times: some of them - a week, others at least 4 days before the procedure. If a woman is of childbearing age, then pregnancy planning will have to be postponed for a period determined by the doctor. Previous surgery requires a test for the presence or absence of tissue capable of absorbing iodine-131. 14 days before the start of the introduction of radioactive iodine, a special diet is prescribed, in which the normal isotope of iodine-127 must be completely eliminated from the body. Product List for effective elimination iodine will be prompted by the attending physician.

Treatment of cancerous tumors with radioactive iodine

If the iodine-free diet is correctly observed and the period of intake restrictions is observed hormonal drugs, thyroid cells are completely cleared of iodine residues. With the introduction of radioactive iodine against the background of iodine starvation, cells tend to capture any isotope of iodine and are affected by β-particles. The more actively cells absorb a radioactive isotope, the more they are affected by it. The dose of irradiation of thyroid follicles that capture iodine is several tens of times greater than the effect of a radioactive element on surrounding tissues and organs.

Whole body scan after sequential radioactive iodine therapy in a patient with papillary thyroid cancer

French experts have calculated that almost 90% of patients with lung metastases survived after treatment with a radioactive isotope. Survival within ten years after the application of the procedure was more than 90%. And these are patients with the last (IVc) stage of a terrible disease.

Of course, the described procedure is not a panacea, because complications after its use are not excluded. First of all, it is sialadenitis (inflammation of the salivary glands), accompanied by swelling, soreness. This disease develops in response to the introduction of iodine and the absence of thyroid cells capable of capturing it. Then the salivary gland has to take over this function. It should be noted that sialadenitis progresses only at high radiation doses (above 80 mCi).

There are cases of violation of the reproductive function of the reproductive system, but with repeated exposures, the total dose of which exceeds 500 mCi.

Treatment after thyroidectomy

Often, cancer patients are prescribed iodine therapy after removal of the thyroid gland. The objective of this procedure is the final defeat of cancer cells remaining after the operation, not only in the thyroid gland, but also in the blood. After taking the drug, the patient is placed in a single room, which is equipped in accordance with the specifics.

Medical personnel are limited to contact for up to five days. At this time, visitors should not be allowed into the ward, especially pregnant women and children, in order to protect them from the flow of radiation particles. Urine and saliva of the patient are considered radioactive and are subject to special disposal.

Pros and cons of radioactive iodine treatment

The described procedure cannot be called completely “harmless”. So, during the action of a radioactive isotope, temporary phenomena are noted in the form pain in the region of the salivary glands, tongue, front of the neck. The mouth is dry, itchy in the throat. The patient is nauseated, observed frequent urges to vomiting, puffiness, food becomes not tasty. In addition, old chronic diseases become aggravated, the patient becomes lethargic, gets tired quickly, and is prone to depression.

In spite of negative points treatment, the use of radioactive iodine is increasingly used in the treatment of thyroid gland in clinics. The positive reasons for this pattern are:

not happening surgical intervention with cosmetic consequences; not required general anesthesia; the relative cheapness of European clinics compared to operations for high quality maintenance and equipment for scanning.

Danger of radiation on contact

It should be remembered that the benefit provided in the process of using radiation is obvious to the patient himself. For the people around him, radiation can play a cruel joke. Not to mention the sick's visitors, let's mention that medical workers care only when necessary and always wear protective clothing and gloves.

After discharge, you should not be in contact with a person closer than 1 meter, and with a long conversation, you should move 2 meters away. In the same bed, even after discharge, it is not recommended to sleep in the same bed with another person for 3 days. Sexual contacts and being near a pregnant woman are strictly prohibited within a week from the date of discharge, which occurs five days after the procedure.

How to behave after irradiation with an isotope of iodine?

Eight days after discharge, you should keep children away from you, especially contact. After using the bathroom or toilet, flush three times with water. Hands are washed thoroughly with soap. It is better for men to sit on the toilet when urinating to prevent splashing of radiation urine. Breastfeeding should be discontinued if the patient is a nursing mother. The clothes in which the patient was on treatment are placed in a bag and washed separately a month or two after discharge. Personal belongings are removed from places common use and storage. In case of emergency admission to the hospital, it is necessary to warn medical staff about the recent passage of a course of irradiation with iodine-131.

In the treatment of thyroid pathologies, radioactive iodine can be used. This isotope has its own dangerous properties, so the procedure for its introduction into the body should be carried out exclusively under the supervision of a highly qualified doctor.

Radioactive iodine - treatment of the thyroid gland

The isotope procedure has the following advantages:

there is no rehabilitation period; there are no scars and other aesthetic defects on the skin; no anesthetics are used during the procedure.

However, radioactive iodine treatment has its drawbacks:

The accumulation of the isotope is observed not only in the thyroid gland, but also in other tissues of the body, including the ovaries and prostate. For this reason, patients should be carefully protected for the next six months after the procedure. In addition, the introduction of the isotope disrupts the production of hormones, which can negatively affect the development of the fetus. Women of childbearing age will have to delay conception for 2 years. Due to the narrowing of the tear ducts and changes in the functioning of the salivary glands, malfunctions in the functioning of these body systems can be observed.

Radioactive (more often I-131) iodine is prescribed in the following cases:

neoplasms on the thyroid gland; thyrotoxicosis; operations on the thyroid gland; hyperthyroidism; diffuse toxic goiter; risk of postoperative complications.

Treatment of thyrotoxicosis with radioactive iodine

According to statistics, in those who are diagnosed with thyrotoxicosis, after treatment with an isotope, the disease recurs after 3-6 months. Such patients are prescribed repeated therapy with radioactive iodine. The use of I-131 for more than 3 courses in the treatment of thyrotoxicosis has not been recorded. In rare cases, radioactive iodine therapy fails in patients. This is observed in the resistance of thyrotoxicosis to the isotope.

Treatment of thyroid cancer with radioactive iodine

The isotope is prescribed to patients in the following dosage:

during therapy - 3.7 GBq; in the case when metastases affected the lymph nodes - 5.55 GBq; with damage to bone tissue or lungs - 7.4 GBq.

Radioactive iodine after thyroidectomy

I-131 is used to detect metastases. 1-1.5 months after surgery, a scintigraphy using radioactive iodine is performed. This diagnostic method is considered more effective. Radiography is a less reliable way to detect metastases. If the result is positive, radioactive iodine therapy is prescribed. Such treatment is aimed at the destruction of lesions.

Preparation for radioiodine therapy

Make sure you are not pregnant. If there is a baby, transfer it to artificial feeding. Tell your doctor about all medications you are taking. 2-3 days before radioiodine therapy, their consumption should be stopped. Stick to a special diet. Do not treat wounds and cuts with iodine. Bathing in salt water and breathing sea air is prohibited. A week before the procedure, walks on the coast should be abandoned.

Diet before radioactive iodine

Such a nutrition system is prescribed 2 weeks before the procedure. It ends 24 hours after therapy. An iodine-free diet before radioactive iodine treatment includes a ban on the following foods:

eggs and food containing them; seafood; red, variegated and lima beans; chocolate and products where it is present; cheese, cream, ice cream and other milk; food, during the preparation of which iodized salt was added; soy products.

Radioactive iodine - how is the procedure performed

For another week, forget about kisses and intimate relationships. Destroy personal items used in the hospital (or put them in a heavy plastic bag for 6-8 weeks). Safely protected. Keep personal hygiene items separate from other family members.

Treatment with radioactive iodine of the thyroid gland - consequences

Due to the individual characteristics of the body, complications may occur after treatment. Radioactive iodine creates the following consequences for the body:

difficulty swallowing; swelling in the neck; nausea; lump in the throat; strong thirst; distortion of taste perception; vomit.

Side effects of radioactive iodine treatment

Although this method of therapy is considered safe for the patient, it also has its downsides. Irradiation with radioactive iodine brings with it the following problems:

vision deteriorates; exacerbated existing chronic ailments; radioactive iodine contributes to weight gain; muscle pain and increased fatigue are observed; the quality of blood worsens (the content of platelets and leukocytes decreases); against the background of a decrease in hormone production, depression and other mental disorders develop; in men, the number of active spermatozoa decreases (cases of infertility have been recorded); increased risk of developing leukemia.

Which is better - radioactive iodine or surgery?

There is no single answer, because each case is individual. Only a doctor can determine what will be the most effective for a given patient - radioactive iodine or surgery. Before choosing a method of dealing with the pathology of the thyroid gland, he will take into account various factors: the age of the patient, the presence of chronic diseases, the degree of damage to the disease, and so on. The doctor will definitely tell the patient about the features of the chosen method and describe the consequences after radioactive iodine.