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Radioactive Iodine for Hyperthyroidism

The most common treatment used to address overact thyroid in the United States.

Radioiodine, or RAI, is given as a pill, to treat hyperthyroidism by gradually shrinking your thyroid—ultimately destroying the gland. Yes, RAI is the same as radioactive iodine threapy, which was the formal medical term. It has been changed to lessen the scariness of sound of this therapy.

This thyroid treatment is much safer than it sounds; in fact, it is the most commonly used hyperthyroid treatment in the US. Unlike antithyroid medications, radioactive iodine is a permanent and more reliable cure for hyperthyroidism.

Radioiodine Ablation
Radioactive iodine therapy can destroy all or part of the thyroid gland, depending on need. While there may be instances when you won't need to have the entire thyroid gland rendered nonfunctional to alleviate your hyperthyroid symptoms, total destruction of the thyroid is most often necessary.

Your doctor may refer to it as radioactive iodine ablation (ablation is a term that refers to destruction or erosion).  This article will focus on what you might expect when you are faced with the total elimination of your thyroid gland and its key functions.

Radioactive iodine therapy for hyperthyroidism requires treatment in pill form. Graves disease, the most common form of hyperthyroidism, occurs most often in women, is treated with radioactive iodine, given as a pill. Photo: 123rf


Radioactive Iodine Testing
Depending on the dose, radioactive iodine can kill a portion, or all, of your thyroid. Your doctor will order a radioactive iodine uptake and scan to determine your dose, the cause of your hyperthyroidism, and information about your thyroid tissue.

In this test, you will ingest a very small dose of radioactive iodine. Your doctor will observe your thyroid's activity level by measuring the amount of iodine it absorbs. He or she will do this using a scan of your thyroid, which will show the healthy and diseased tissues.

In determining the best dose, the size of the thyroid gland (determined by a physical exam) and results of the uptake test are the two most important factors. The larger the gland, the larger the radioactive iodine dose. The higher the iodine uptake, the smaller the dose.

How Radioactive Iodine Works
Radioactive iodine is available in an oral pill, so you won't need to be hospitalized. After you take the pill, your doctor will recommend drinking lots of fluids to prompt the release of the radioactive iodine through your urine.

Fortunately, radioactive iodine therapy is targeted to treat only your thyroid gland. Thyroid cells are the main cells in the body that can absorb iodine, so there is very little radiation exposure to the rest of your body's cells. When the thyroid cells absorb the radiation, they are damaged or destroyed.

Approximately 90% of patients need only one dose before they are cured of their hyperthyroidism. Though you may only need a single dose, it may take up to six months before the medication fully destroys all or part of the thyroid. Fortunately, most patients experience reduced symptoms about a month after treatment.

If your symptoms persist 6 months after treatment, you may need a second dose. In the rarest of cases, some patients will not benefit from a second dose and may instead require surgery.

Side Effects of Radioactive Iodine
The most common side effect of radioactive iodine may seem ironic, yet it makes perfect sense—hypothyroidism. The radioactive iodine often kills an excessive amount of thyroid cells, leaving the thyroid unable to produce enough hormones—the opposite problem you had before.

It might seem odd to replace one disorder with another, but hypothyroidism is much easier to treat on a long-term basis than hyperthyroidism. If you develop hypothyroidism, you will need to take life-long thyroid hormone replacement therapy , but it is a safe, reliable, and cost-effective treatment.

Other side effects of radioactive iodine include:

  • Metallic taste in the mouth: This can last for a few weeks.
  • Nausea: This usually subsides one to two days after treatment.
  • Swollen salivary glands: This can last for a few weeks. It is caused by iodine absorbed by the salivary glands, though stimulating saliva flow a day after treatment (by sucking a lemon drop, for instance) is an effective remedy.

Note: Don't let your fears about radiation give you the wrong impression about this therapy. Radioactive iodine used in this manner will not cause thyroid cancer or impair fertility.

A Special Caution for Women
Pregnant women or women who want to become pregnant in the next 6 months should not use radioactive iodine, as the treatment can destroy the fetus's thyroid and impair its development. In fact, women should wait a year before conceiving if they have been treated with the therapy. Women who are breast-feeding should also not use radioactive iodine.

After Treatment
In the days following radioactive iodine therapy, you will need to take certain precautions to prevent radiation exposure to others. Keep in mind that the precautions listed below are general, and your doctor will be more specific about how many days and what kinds of precautions you need to follow tailored to your individual needs and medical circumstances.

  • You should sleep alone for 3 to 5 nights after treatment, depending on the strength of your dose.
  • Personal contact with children (hugging or kissing, for example), should be avoided for 3 to 7 days, depending on the strength of your dose.
  • For the first 3 days after treatment, stay a safe distance away from others (6 feet is enough). Avoid public places and drink plenty of water (to encourage the removal of radioactive iodine through your urine).
  • For the first three days, do not share items (utensils, bedding, towels, and personal items) with anyone else. Do your laundry and dishwashing separately. Wipe the toilet seat after each use. Wash your hands often, and shower daily.
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