Is radioactive iodine treatment prescribed? All about treatment of the thyroid gland with radioactive iodine. Radioactive iodine

Radioiodine therapy consists of 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, entering the body, begins to disintegrate, resulting in the release of beta and gamma radiation. Beta particles have no effect on thyroid gland and are released very quickly. And gamma particles are stronger and are able to penetrate any organs of the patient. Based on the emitted gamma waves, a special device can be used to determine the distribution of iodine throughout the body.

Radioiodine therapy drugs 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 is absorbed only by the cells of the thyroid tissue, mainly in the central location. At the site of dead cells are observed fibrotic changes, but the remaining peripheral cells are able to secrete small amounts of hormones. Radioactive iodine also has a detrimental effect on metastases, including distant ones.

Treatment with radioactive iodine for thyroid cancer

Cancer treatment thyroid gland radioactive iodine is carried out in specialized clinics, since the patient needs to be protected from contact for several days.

How is radioactive iodine treatment for the thyroid gland performed?

First, the patient is prescribed an examination, based on the results of which an individual dosage of radioactive iodine is selected.
If necessary, special preparation is carried out aimed at improving iodine absorption.
The patient is given a liquid drug or capsules. The medicine should be taken with plenty of water.

Typically, 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.

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

After treatment, the patient is regularly examined to determine whether all thyroid tissue and metastases have been destroyed. The therapeutic effect can be fully assessed 3-4 months after treatment.

Indications and contraindications for treatment

Radioactive iodine is used for medical purposes according to strict indications. Before starting therapy, the patient must undergo full examination to confirm the diagnosis.

Indications for use:

malignant tumors;
secondary tumors due to cancer;
severe forms of thyrotoxicosis;
relapse of thyrotoxicosis;
inoperable tumors.

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

renal and liver failure;
multinodular goiter, volume more than 40 ml;
hypersensitivity to the drug;
thyroiditis occurring after pregnancy;
acute stage of gastrointestinal ulcers;
diabetes mellitus, decompensated stage;
behavioral disorders, mental illness;
aplastic anemia;
disorder of hematopoiesis in the cat’s brain;
HIV, immunodeficiency conditions.

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

Attention! During pregnancy, radioactive iodine preparations penetrate the fetal thyroid gland, causing the risk of radioactive contamination.

What are the pros and cons of radioactive iodine treatment?

Treatment with radioactive iodine has its advantages and disadvantages. These should be taken into account before prescribing therapy.

Advantages of radioiodine therapy:

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

Flaws:

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

The gonads are exposed to a certain dose of radiation, so you can plan a pregnancy only a year after therapy. You should consult your doctor about the possibility of pregnancy, since recovery of the body directly depends on the amount of the drug taken.

Surgery or radioactive iodine, which to choose?

The question often 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 surgery.

But for malignant tumors it is a necessity. Radioactive iodine is prescribed after surgical removal malignant neoplasm. An integrated approach to treatment allows you to completely destroy the cells of the thyroid tissue of the thyroid gland remaining after surgery.

Preparation for therapy

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

After hormone therapy is discontinued, it increases in the body, which promotes better uptake of iodine isotopes by the thyroid gland. Best effect achieved if the concentration 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 a minimal amount of iodine can help achieve the required level of the hormone and should begin two weeks before the start of therapy.

Necessary examinations:

Tests for thyroid hormones, TSH, calcitonin.
Calcium and phosphorus tests.
Ultrasound examination of the neck.
Scintigraphy.
X-ray of the lungs.
Checking the function of external respiration.

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

Possible diets and nutritional correction during radioiodine therapy

The oncologist prescribing radioactive iodine treatment should warn him about the importance of an iodine-free diet. Low iodine in the diet, as well as the abolition of thyroid-stimulating hormones, is required to prepare the thyroid gland.

What should you exclude from your 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 dishes, refuse fast food and food in in public places– it is necessary to cook only at home from approved products.

What can you eat?

Egg-free pasta.
White and brown rice.
One serving of cereal per day.
No more than 150 g of meat per day.
2-3 servings of river fish per week.
Jelly based on gelatin.
Egg white.
Bitter chocolate.

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

Treatment after thyroidectomy of the thyroid gland

Radioactive iodine is administered after thyroidectomy. This sequence makes it possible to completely destroy 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 organ removal can improve survival rates for differentiated types of cancer.

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

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

What rules must be followed?

It is forbidden to leave the room.
After visiting the toilet, empty the tank twice.
Take a shower 1-2 times a day.
Rinse hygiene items (brush, comb, razor) with running water.
Avoid getting saliva, vomit and feces on the floor.
You cannot feed leftover food to animals and birds - everything is disposed of in special containers.
Hygiene items and clothing remain in the ward after discharge for disposal.
Drink enough clean water.

Attention! For 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 through 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, and also refuse to visit the pool and public baths.

Consequences of treatment with radioactive iodine

Radioiodine therapy can cause complications.

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

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

Long-term side effects are not typical for radioiodine therapy. Iodine preparations are quickly eliminated from the body without having a carcinogenic effect. Even if a slight impact of radiation is exerted on the gonads, 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 needs to 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?

Nuclear medicine centers in Kazan and Krasnoyarsk.
Federal State Budgetary Institution "RNTsRR" of Moscow.
Arkhangelsk medical Center named after N.A. Semashko.
"MRNC" named after. A.F. Tsyba" Obninsk.
City hospital No. 13, Nizhny Novgorod.
Omsk regional hospital.

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

Attention! You can get a quota under the compulsory medical insurance policy - get treatment for free. To do this you need to assemble a package necessary documents and wait for the decision of the medical commission.

Radioactive iodine is an alternative method that is used if the organ is completely removed. This therapy is effective for differentiated forms of cancer and other diseases of this organ. In some cases, this method is the patient’s only chance for a favorable outcome. The feasibility of the procedure is determined by a qualified specialist based on the established diagnosis.

Radioactive iodine 131 - what is it?

Iodine is important element in the human body, which has the ability to accumulate and be retained by the cells of the thyroid gland. This allows the body to use the component to produce thyroid hormones necessary for the normal functioning of vital organs and systems of the body.

Radioactive iodine 131 is a synthetically synthesized isotope of iodine. The substance is tasteless, colorless and odorless. In medicine, this component is used to treat various diseases thyroid gland. The therapeutic effect is based on the fact that when radioactive iodine enters the body, it self-disintegrates within 8 days and forms xenon, as well as beta and gamma radiation. This feature of the substance is the main goal of treatment, as it helps to destroy tumor cells.

90% of the therapeutic effect is achieved thanks to beta particles, which have a high speed of movement and a short distance in the tissues (2 mm). Their radioactivity helps destroy residual thyroid cells and tumors that have spread beyond its boundaries.

Gamma particles do not have a therapeutic effect, but are characterized by high penetrating ability. Thanks to this, using special gamma cameras, it is possible to detect the presence and location of metastases in which accumulation of radioactive iodine is detected.

The essence of the radioiodine therapy method

This method of treatment is used for patients who have undergone surgical removal thyroid gland. The procedure is used after 4 weeks after surgery.

When radioactive iodine is introduced into the body, residual organ cells and tumors capture and accumulate it. Thanks to this, they are destroyed, which makes it possible to stop the development of the disease. As a result, the function of the thyroid gland is completely suppressed. The isotope does not affect adjacent tissues.

The required dosage of the substance is selected by an experienced specialist based on the form and stage pathological process.

Indications for use

Radioiodine therapy for the thyroid gland is prescribed only when its effectiveness is fully justified.

Main indications for the procedure:

hyperthyroidism due to increased activity of the thyroid gland;
thyrotoxicosis;
nodular goiter;
papillary, follicular, anaplastic cancer;
presence of metastases.

Experts divide all patients suffering from thyroid cancer into three main risk groups. Each of them means the degree of likelihood of re-development of the disease, as well as the appearance of metastases.

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

Low risk group. The size of the tumor does not exceed 1-2 cm, so the tumor does not extend beyond the thyroid gland, and there are no metastases. Radioiodine therapy is not prescribed in this case.
Medium risk group. The diameter of the tumor exceeds 3 cm, so it has grown into the capsule. The dosage of radioactive iodine is 30-100 mCi.
High risk group. The size of the tumor rapidly increases, which leads to its growth into neighboring tissues, and distant metastases are also present. The amount of radioactive iodine is prescribed from 100 mCi.

Contraindications

According to reviews, treatment of the thyroid gland with radioactive iodine is very effective, but this therapy is not useful for everyone.

Main contraindications:

pregnancy;
large or multinodular goiter;
individual iodine intolerance;
lactation;
thyroiditis after childbirth;
psychiatric diseases;
hepatic, renal failure;
severe form of decompensated diabetes mellitus;
hypoplastic, aplastic anemia;
stomach ulcer, duodenal ulcer during exacerbation.

Radioiodine therapy is only permitted for patients over 18 years of age.

Benefits of radioiodine therapy

Judging by the reviews, treating the thyroid gland with radioactive iodine has a number of advantages. This is confirmed by experts who claim that using this method it is possible to target the thyroid gland and tumors present in it without involving adjacent tissues in the process.

The main advantages of radioiodine therapy:

no need for anesthesia;
low relapse rate;
no scars remain after the procedure;
minimal number of contraindications;
short rehabilitation period.

Preparation for the procedure

In order for the therapy to be as effective as possible, it is necessary to prepare the patient in advance for the use of the isotope. The main role in the effectiveness of treatment is given to thyroid-stimulating hormone (TSH), which is synthesized by the pituitary gland. Since it is he who is responsible for the accumulation of iodine by the thyroid gland.

Malignant cells have a lower absorption capacity, so it is necessary to create increased level TSH in the body to improve the uptake of radioactive iodine by the tumor.

There are two main ways to increase the level of thyroid-stimulating hormone to the required level.

Suspense replacement therapy. You should stop taking medications 3-6 weeks before radioiodine therapy. In this case, TSH reaches 30 or higher, which is much higher than the normal range. The disadvantage of this method is the appearance of hypothyroidism, accompanied by unpleasant symptoms.
Injections of "Thyrogen" (recombinant human TSH). The drug is administered several days before the isotope is used, which can significantly accelerate the increase in hormone levels.

Both methods of increasing TSH are effective, but which one to choose is determined by the doctor, depending on the individual characteristics patient.

In addition, it is necessary to comply with some general recommendations to prepare the body for the effects of isotrope.

Eliminate external exposure to iodine. This means that you should not swim in salt water, breathe sea air, or lubricate wounds with iodine. All these requirements must be met for four days before starting radioiodine therapy.
Stop taking vitamins, hormonal medications and nutritional supplements 1 month before the procedure.
Women should be examined for pregnancy, as the isotope negatively affects the development of the fetus.
Stop taking medications for hyperthyroidism 7 days before the procedure.

Necessary diet

Adjusting nutrition is also an important condition for preparing a patient for radioiodine therapy. The diet implies a significant reduction in the diet of foods containing iodine. This is a necessity to create a deficiency of this component in the body. As a result, this will lead to active absorption of radioactive iodine by tumor cells.

You must adhere to the diet for 2 weeks before therapy and for 5-7 days after it.

Acceptable products:

fresh meat (no more than 140 g per day);
fresh apples, oranges, lemons, grapefruits;
pasta;
egg whites.

It is also allowed to eat unsalted nuts, vegetable oil, sugar, honey, fruit jam, tea, raisin compote, peanut butter.

Prohibited products during this period:

any seafood;
egg yolks;
chocolate;
dairy products;
iodized salt;
soy and products based on it;
sausage;
all products that have an orange, brown and red tint;
coffee;
ice cream.

How is the treatment carried out?

Radiotherapy is carried out in a hospital setting. The patient must swallow the capsule or water solution radioactive iodine and drink plenty of water (at least 400 ml).

After this, the patient is isolated in a separate room, since the radiation from it poses a danger to others. Therefore, initially you need to take a minimum of things with you, since they are subsequently subject to disposal.

Within 2 hours after the procedure, solid food is prohibited, since during this period iodine is actively absorbed by the thyroid gland and tumor cells.

Radiation measurements are carried out at least once a day, and until this indicator drops to normal level, the patient will be isolated from others. On average, this period lasts from 3 to 7 days.

Side effects

The consequences of treatment with radioactive iodine for the thyroid gland can be different. In each person they are expressed differently depending on age and the volume of the injected isotrope.

The most likely side effects of radioiodine therapy for the thyroid gland are:

nausea;
vomit;
general weakness;
decreased appetite;
swelling in the neck.

Radiotherapy in 30% of patients is accompanied by inflammation of the salivary glands. This unpleasant symptom appears 24 hours after the procedure and is often caused by the introduction of a large amount of isotrope against the background of residual thyroid tissue.

According to reviews, treatment of the thyroid gland with radioactive iodine causes a change in taste sensations in a third of patients. At the same time, the food becomes tasteless or acquires metallic taste. This symptom goes away on its own after 10-15 days.

The use of an isotrope can provoke an exacerbation of chronic diseases such as cystitis, pyelonephritis, gastritis. To eliminate unpleasant consequences, symptomatic therapy is prescribed.

There is still no substantiated evidence that radioiodine therapy has Negative influence for conceiving and bearing a child. But planning for children is recommended only a year after this procedure.

Recovery period

The duration of rehabilitation after radioiodine therapy for the thyroid gland is about 1 month. During this period, a person must adhere to the doctor’s recommendations, which will help protect others from the possibility of radiation exposure, and also speed up the patient’s recovery.

It is necessary to increase water consumption to 1.5-2 liters per day, which will speed up the process of removing the isotope from the body.
You need to shower at least 2 times a day.
You should approach others and pets no more than 1 m; kissing and hugging children is prohibited.
You should sleep alone and in a separate room.
Men should urinate while sitting.
After visiting the toilet, the tank must be flushed twice along with the used toilet paper and wash your hands thoroughly with soap.
All personal hygiene items should be kept in a plastic bag.
It is recommended to use separate dishes.
Bed linen and clothing must be washed daily.
If possible, limit contact with loved ones for the entire period of rehabilitation.
The doors of your room should be kept closed.

All restrictions are temporary; after 30 days, the person will be able to return to their usual lifestyle.

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 makes it possible 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 functional research the functioning of an organ, 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 an 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

More often radioisotope research 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 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;
3 weeks in advance, any diagnostic studies requiring intravenous administration of a radiocontrast agent are excluded.

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.
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 a fine-needle biopsy and subsequent morphological research the obtained biomaterial.

Just something complicated

Radioactive iodine is used to treat hyperthyroidism; it gradually reduces the volume of the thyroid gland down to its complete destruction. 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 are:

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 salivary glands are the first to react; 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

In the toxic form of goiter (nodular or diffuse), hormones are present in excess, which predisposes to thyrotoxicosis. In case of diffuse damage to the endocrine gland, hormones are produced by the entire tissue of the organ; in case of nodular goiter, the formed nodes produce hormones.

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 be for a long time nearby (closer than 1 meter), avoid public crowded places, avoid sexual contact for 3 weeks.

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

Cancer

Cancerous tumors are mutated normal cells. As soon as at least one cell acquires the ability to divide at a high speed, they talk about 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 the entire body is considered more effective.

For effective treatment 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.

If an endocrine gland is removed, there is a way to raise TSH levels - 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:

fatigue;
depression;
weight gain;
constipation;
muscle pain;
decreased concentration.

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 violation menstrual cycle, since radioiodine treatment affects the ovaries. Accordingly, it should be excluded breast-feeding.
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 modern way regain lost well-being with minimal risk to health.

Patient's reminder when undergoing a course of therapy

radioactive iodine (I-131).

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

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

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

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

Continue to use as often as possible chewing gum, lemon and sour sucking candies for a week (to quickly cleanse the salivary glands of radioactive iodine).

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

· If you have to go to the hospital unexpectedly or have an emergency, please tell your doctor that you have recently taken radioactive iodine. This is also required even if you were taken to the same hospital where you underwent radioiodine therapy.

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

Number of visits to doctors malignant tumors thyroid gland in last years does not decrease, but only increases. Moreover, among patients, more and more often there are not only mature people, but also the younger generation who also have thyroid diseases. Neoplasms are predominantly quite aggressive and exhibit early metastasis, which inevitably reduces people’s chances of a favorable outcome.

At complex treatment for thyroid diseases, a popular method is radioiodine therapy, which gives good results and greatly improves the prognosis when diagnosed with thyroid cancer. After using the method, the chances of getting rid of metastases increase, as well as increasing the period of remission. Let's figure out what radioiodine therapy is and what the benefits are. this method in general and regarding treatment.

What is radioiodine therapy

Radioiodine therapy is the use of radioactive iodine, which medical terminology also called radioiodine I/131. This type of iodine is one of 37 isotopes of iodine-126, which can be found in any first aid kit.

During use, radioiodine, which has a half-life of 8 days, spontaneously dissolves in the human body. Xenon is being formed, as well as radioactive radiation such as gamma and beta radiation.

The therapeutic effect is achieved thanks to the flow of particles of the “beta” type (or fast electrons), one of the properties of which is increased penetration into body tissues located near the accumulation of iodine due to the good emitted speed. Beta particles penetrate 0.5-2 millimeters deep. And since the radius of their work is limited only by these numbers, iodine performs its functions only within the thyroid gland.

Gamma particles also have good permeability, which ensures their passage into any human tissue. To register them, special equipment and special cameras are required. There is no therapeutic effect from gamma particles, but the radiation makes it possible to detect areas of iodine accumulation. When scanning the human body with a gamma camera, the doctor can easily determine the zone of isotope formation.

This information is very valuable for cancer patients, since identified lesions that appear after treatment with radioiodine therapy help indicate the presence of malignant metastases.

The main goal of therapy is complete disposal of the affected thyroid tissue.

The effect can be expected several months after the start of treatment. For those who experience a relapse of the pathology, a repeated therapeutic course is often prescribed so that the thyroid disease stops bothering the patient.

Indications and contraindications

Radioiodine therapy is indicated for people suffering from:

increased activity of the thyroid gland, which causes benign nodular neoplasms ();
a condition, the peculiarity of which is an excess of thyroid hormones, and which is a consequence;
all types of thyroid cancer, which are characterized by the appearance of malignant neoplasms in the tissues of the diseased organ, with the presence of an inflammatory process;
distant metastases that are capable of selectively “accumulating” the isotope.

Treatment of thyroid cancer with this method is due to the insignificant effect of iodine on other organs.

If the goal is to treat thyroid cancer, when it makes sense to get rid of organ tissue that is present after surgery or when affecting lymph nodes and other parts of the body, iodine therapy is also used.

Radioactive treatment has the potential to improve survival in patients with other forms of cancer, such as follicular and papillary cancer. Treatment of thyroid cancer in these cases is quite standard practice.

For treatment of thyroid cancer to have maximum effect, the patient must have a high level of thyroid-stimulating hormone in the blood. It increases the absorption of incoming iodine by diseased cells.

The method is also justified in case of relapse of the pathology, when an operation has already been performed and the thyroid gland has been removed. Most often they occur when removing a diffuse goiter of a toxic type.

Postoperative complications have a high probability. For this reason, many specialists are increasingly choosing radioactive iodine treatment.

The method in question is strictly contraindicated for:

pregnancy, since fetal malformations after exposure cannot be excluded;
breastfeeding.

Pros and cons of the procedure

If we compare the procedure for treating the thyroid gland with radioactive iodine with surgery, it has certain advantages:

there is no need for anesthesia;
there is no difficult postoperative period;
scars and scars in the neck area are excluded;
a portion of iodine is taken once, possible discomfort after treatment they are quite easily eliminated using local medications;
a large proportion of the radiation received during the procedure falls on the thyroid gland, only a small part reaches neighboring organs;
the dose of exposure is determined in each case individually and depends on the type of illness;
there is no threat to life, as, for example, with repeated surgery.

It is important to note the disadvantages of therapy:

small doses of iodine can accumulate in female body, for example, in the epididymis, mammary glands or ovaries. In men, there are cases of accumulation in the prostate;
There are examples of visual impairment and development;
sometimes patients note excessive fatigue, muscle pain, changes in weight;
chronic diseases worsen;
taste sensations change, nausea and vomiting appear;
After undergoing the procedure, you will have to spend several days in isolation, since the body will emit radiation that is dangerous to others.

Which is preferable: surgery or radioactive iodine?

Opinions on this issue differ even among specialists who have been practicing thyroid treatment for many years.

Some strictly adhere to the opinion that after surgery to remove the thyroid gland, a person taking a lot of medications can continue to lead his usual lifestyle.

Proponents of radioiodine therapy for the thyroid gland claim that there are no significant side effects that will inevitably be encountered during surgery.

There are experts who greatly exaggerate when they say that therapy can lead to full functioning of the thyroid gland. But this statement is very erroneous, because therapy is characterized by complete suppression of the organ’s functioning.

Thus, both treatment approaches achieve an identical goal. Therefore, you will have to choose individually in each specific case, listening to the advice of a specialist whom you trust with your own health. Radioactive iodine is good because it is absent painful sensations, invasiveness. There is no risk of complications that are possible after surgery.

Preparatory activities before therapy

It is worth preparing to take the isotope half a month before the start of treatment.

Avoid contact with iodine on the skin surface before therapy. Do not use the product in the treatment of wounds and cuts, or make an iodine mesh;
do not visit salt caves, do not swim in sea water, do not travel to places with sea air saturated with iodine;
cancel appointment vitamin complexes, additives, medicines that contain hormones or iodine;
for women to exclude the possibility of pregnancy;
Before taking capsules with the substance, it is worth doing a test showing the absorption of radioactive iodine by thyroid tissue.

If there was surgery to remove the gland, it is worth conducting a test to determine the sensitivity to iodine of the lymph nodes and lungs, since they perform the accumulative function of iodine in this group of patients.

Iodine-free diet before radioiodine therapy

If the decision to carry out therapy has already been made, you should think about adjusting your diet and using an iodine-free diet. Foods that contain large amounts of iodine should be removed from the diet.

It is prohibited to consume when using an iodine-free diet:

seafood, seaweed and seaweed;
dairy products, egg yolks;
products containing soy;
citrus fruit varieties, like apples, grapes and persimmons;
red beans;
Hercules;
products containing red food colorings.

During the iodine-free diet, the menu may look like this:

about 150 grams of meat per day;
about 200 grams of cereal or porridge;
200 grams allowed pasta per day, not containing eggs;
vegetables and fruits except those not prohibited by the diet;
nuts;
honey or sugar;
herbal seasonings;
salt that does not contain iodine;
vegetable oils;
tea, a small amount of coffee.

An iodine-free diet before radioiodine therapy may look quite simple and tasty at the same time. The iodine-free diet menu for a specific day is compiled in such a way that the diet is as complete as possible. The day usually starts with porridge, sweet tea and fruit.

For lunch, it makes sense to prepare vegetable soup, boiled meat with a side dish, some unleavened bread, and compote. For dessert, honey with nuts is allowed. A good option dinner, if you follow an iodine-free diet, can be a piece of lean fish and vegetables, as well as tea with jam.

Treatment procedure after thyroidectomy

The procedure in question is often performed on patients with cancer who have already undergone surgery to remove the gland. The main goal of treatment is to completely get rid of the abnormal type of cells that could remain in the area of the removed thyroid gland and in the blood plasma.

The person who took the drug is located in an isolated room, which is equipped based on the characteristics and specifics of the treatment being carried out. Staff contacts patients only when absolutely necessary or for procedures. Treatment after radioiodine therapy includes a number of simple recommendations.

Individuals treated with radioactive iodine should:

to accelerate the removal of decomposition products of the main active substance, drink enough liquid;
wash as often as possible;
use personal hygiene items;
When using the toilet, flush yourself twice;
try not to have close contact with children: do not hug, do not pick them up. It is worth temporarily eliminating contact with infants altogether;
the first few days after discharge you should sleep alone, minimize close contacts with healthy people;
do not communicate with pregnant women for the first week after discharge;
upon entering a medical facility, immediately inform the staff that you have already been treated with radioactive iodine;
Take thyroxine for life, and also visit an endocrinologist twice a year.

In all other respects, life will be the same as before treatment. The above conditions will only occur for a short period of time after radioiodine therapy for the thyroid gland.

Consequences

Treatment with radioactive iodine often causes deterioration of the thyroid gland, so hypothyroidism does not develop. Insufficient amounts of hormones for a given period of time must be restored with the help of medications. When the level of hormones has been restored, you can then live without restrictions and limits, except in the situation when the organ is completely removed.

Studies have shown the possibility of some unpleasant consequences after treatment of thyroid disease:

acute symptoms of deterministic effects;
long-term effects that are often invisible to humans or appear after a certain period of time. At first glance, feeling well after a course of treatment does not guarantee side effects.

Acute side effects

When treatment with radioactive iodine is completed, a state of general intoxication is usually present. It manifests itself in the form of vomiting and nausea. The patient may have a fever, he is quite weak, and muscle pain is felt.

The described symptoms are quite individual and disappear within 2-3 days after therapy. If the condition is too tense, you can take medications to relieve unpleasant symptoms in order to rid the body of the intoxicating load.

Common side effects are swelling, tension in the cervical area, painful swallowing. This condition is a consequence of the action of radioiodine on the remains of the organ. The described symptoms after treatment of thyroid disease most often disappear without additional interventions within 2 weeks from the moment of therapy.

Radioiodine therapy, after which approximately 10% of people experience inflammation of the salivary gland near the ear, can cause dry mouth, impaired swallowing of solid foods, and swelling in the ear area. As a form of prevention, intensive drinking, chewing tablets, and sour candies are prescribed.

The technique negatively affects the gastrointestinal tract; there are cases of the development of radiation-induced gastritis and enteritis. The condition after radioiodine therapy may be such that a person feels pain in the abdomen, feels nauseous, and appetite worsens. But such symptoms are usually minimal and go away on their own in less than a week. In some countries, an encapsulated radioactive drug is used, which makes it possible to significantly reduce negative impacts on the gastric mucosa.

Some cases suggest that high doses of iodine lead to inhibition of the hematopoietic functions of the bone marrow. There is a decrease in red blood cells, platelets and leukocytes, but this condition also goes away after a couple of months, you just need to follow the requirements of the attending physician regarding lifestyle and the need to take additional pharmaceuticals to alleviate unpleasant symptoms following treatment.

Long-term consequences

Over many years of using Iodine I-131, there have been no confirmed cases of carcinogenic diseases as a result of therapy. Research suggests that radioiodine is absorbed by cells that have special receptors on their surface that are susceptible to it. Treatment with radioactive iodine is safe, the effect on other tissues and cells is minimal, which makes it possible to expand the scope of the method.

A pressing issue remains the mutagenic and teratogenic consequences of the use of therapy. Long-term studies do not confirm mutagenic effects. Short half-life, no accumulation, the ability to preserve genetic material, rapid restoration of reproductive functionality is possible within a year after treatment.

Where is radioiodine therapy treated in Russia?

Radioactive treatment in Russia is carried out in many clinics:

RNTsRR "Russian science Center X-ray radiology";
Arkhangelsk "Northern" clinical center Semashko";
Kazan “Center for Nuclear Medicine”;
Obninsk Scientific Center Tsyba;
Krasnodar "Center for Nuclear Medicine of the Siberian Center of the FMBA."

How much does treatment cost?

Having a compulsory health insurance policy, people in need of therapy can count on receiving a free type of quota. First, you should contact one of the medical institutions to find out whether it is possible to carry out treatment with them. Specialists will give an answer about the possibility of treatment and the advisability of the quota. Practice shows that the chances of getting a quota at the beginning of the year are much greater than at the end.

Paid treatment will be faster; you won’t have to wait and find out about the possibility of obtaining a quota. All you have to do is choose a clinic for treatment and start therapy.

The cost of treatment will depend on the level of the medical institution, the qualifications of its staff and, of course, the dosage of the substance. On average, in paid clinic therapy can cost from 70 to 130 thousand. There are clinics where the price of the procedure is around 180 thousand rubles.

Information about the cost of the required therapy must be clarified when personal contact with the clinic, choosing the one that inspires trust and peace of mind. After all, in the end, the effectiveness and success of further treatment will depend on this.