Radioactive Iodine (I-131) Therapy for Hyperthyroidism

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Radioiodine therapy, also known as a nuclear medicine treatment, combats an overactive thyroid (hyperthyroidism) and may also treat thyroid cancer. When a small dose of radioactive iodine I-131, an iodine isotope that emits radiation, is ingested, it’s absorbed into the bloodstream and concentrated by the thyroid gland, where it starts destroying the gland's cells.

Your doctor will guide you on preparation, necessary radiation safety precautions, and when to stop taking anti-thyroid medications. If you are pregnant or breastfeeding, inform your doctor. Discuss any recent illnesses, medical conditions, allergies, and medications you are taking. The procedure requires minimal preparation, though you should avoid eating or drinking after midnight on the treatment day.

What is Radioiodine (I-131) Therapy and how is it used?

Radioactive Iodine I-131 therapy is a nuclear medicine treatment used to treat hyperthyroidism caused by Graves' disease or overactive nodules within the thyroid gland.

Nuclear medicine employs small amounts of radioactive material called radiotracers. This discipline helps diagnose, evaluate, and treat various ailments, including cancer, heart disease, gastrointestinal, endocrine, and neurological disorders. Nuclear medicine tests highlight molecular activity, potentially identifying diseases in early stages or showing treatment efficacy.

The thyroid, a gland in the neck, produces hormones that regulate the body's metabolism by converting food into energy. An overactive thyroid accelerates metabolism by producing too many hormones. Ingesting a small dose of I-131 allows it to be absorbed into the bloodstream and concentrated by the thyroid, where it destroys the gland's cells. This method is also used to treat thyroid cancer.

Who will be involved in this procedure?

A radiologist with specialized nuclear medicine training, alongside an endocrinologist, thyroid surgeon, and radiation safety officer, will comprise your treatment team.

What equipment is used?

There is no special equipment used during radioactive iodine therapy; the patient only needs to swallow a prepared dose.

Who operates the equipment?

No equipment is required during radioactive iodine therapy; the patient simply ingests a prepared dose.

Is there any special preparation needed for the procedure?

Avoid food and drinks after midnight on the day of the procedure. Stop taking anti-thyroid medications at least three days before, often five to seven days prior as per your doctor's recommendations.

You can return home after radioactive iodine treatment but should avoid prolonged close contact with others, especially pregnant women and small children, for several days. Most unabsorbed radioactive iodine exits the body primarily through urine within the first two days, and small amounts also through sweat, saliva, tears, vaginal secretions, and feces.

If your work or activities involve prolonged close contact with small children or pregnant women, wait several days before resuming them. Arrange alternative care for infants during the first days post-treatment. Your radiologist will provide specific advice, typically for two to five days.

Follow your treatment team's guidelines and comply with the Nuclear Regulatory Commission's precautions, including:

• Using private toilet facilities and flushing twice after each use.
• Bathing daily and frequent hand washing.
• Drinking a normal amount of fluids.
• Using disposable eating utensils or washing them separately.
• Sleeping alone and avoiding prolonged intimate contact for three to four days. Brief close contact like handshaking and hugging is allowed.
• Daily laundering of linens, towels, and clothes separately at home.
• Avoid prolonged food preparation for others using bare hands.
• Cease breastfeeding several days before the procedure.
• Avoid pregnancy for six months to a year after treatment.
• Ensure you are not pregnant before receiving I-131, with a pregnancy test required within 24 hours prior to the treatment for women of child-bearing age not surgically prevented from pregnancy.

If travel is necessary immediately after radioactive iodine treatment, carry a physician's letter of explanation. Radiation detection devices in airports and federal buildings may detect radiation in patients up to three months post-treatment. Depending on the radiation dose administered, continued precautions might be necessary for several weeks.

RAI therapy is not used in pregnant patients due to potential thyroid gland damage to the baby. It should also be avoided in breastfeeding mothers unless they are willing to stop. Pre-menopausal women should discuss I-131 use with their doctor comprehensively.

How is the procedure performed?

Generally, hyperthyroidism treatment is outpatient-based due to the small dose required. The radioiodine I-131 is ingested as a capsule or liquid, rapidly absorbed into the bloodstream through the gastrointestinal tract, and concentrated by the thyroid to destroy its cells. Though radioactivity remains in the thyroid for some time, it significantly reduces within days. The effect takes one to three months to manifest, peaking between three to six months post-treatment. Usually, one dose suffices, with a second treatment rarely needed, and a third almost never.

What will I feel during this procedure?

Post-therapy, patients might experience thyroid pain resembling a sore throat. Over-the-counter pain relievers can be recommended by your doctor.

Are there permanent side effects from radioactive iodine therapy?

Expect some or most of your thyroid gland to be destroyed. Since thyroid hormones are crucial for metabolism, thyroid hormone pills, prescribed one daily, are required lifelong post-procedure. The pills are inexpensive and the risk of cancer from this therapy is minimal.

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Radioactive Iodine Therapy: What It Is, Benefits & Side Effects

How do I prepare for radioactive iodine therapy?

You’ll likely meet with your healthcare team at least a month in advance to go over the details of RAI therapy and how to prepare. Preparation steps may include:

• Blood tests to check your thyroid hormone levels.
• Stopping thyroid-suppressing medicines at least one week before the procedure.
• Following a low-iodine eating plan for one to two weeks before the procedure.
• Receiving thyroid-stimulating hormone (TSH) injections to increase iodine absorption.
• Stopping breastfeeding at least six weeks before the procedure if willing to cease.

Just before the procedure, you may:

• Need a pregnancy test, as RAI therapy isn’t safe during pregnancy.
• Have a body scan for thyroid cancer to check lingering cancer cells.
• Take anti-nausea medication.

Your healthcare team will detail all preparation steps. Follow their instructions diligently and don’t hesitate to ask questions.

What happens during radioactive iodine therapy?

RAI therapy is brief—either swallowing radioiodine or receiving an IV injection at a hospital. Preparation and post-treatment precautions are more time-consuming than the procedure itself.

RAI therapy procedure for hyperthyroidism

For hyperthyroidism, you take radioactive iodine orally as a single capsule or liquid dose, usually on an outpatient basis. The bloodstream quickly absorbs it in the gastrointestinal tract, concentrating it in the thyroid gland. The iodine causes the thyroid to shrink and reduces hormone levels.

RAI therapy procedure for thyroid cancer

For thyroid cancer, radioactive iodine is taken orally or via IV injection. This larger dose treatment may require hospitalization. Often, just one dose suffices, though some may need a second treatment to target remaining thyroid cancer tissue.

What happens after RAI therapy?

After receiving radioactive iodine, a healthcare provider monitors you for complications. Depending on the dose and other factors, you might go home afterward or need hospitalization.

What happens to your body after radioactive iodine therapy?

Radioactive iodine stays in the body briefly, mainly exiting through urine in the first days post-treatment, with smaller amounts excreted in saliva, sweat, and feces.

What precautions should I take after RAI therapy?

RAI therapy primarily affects the thyroid, but you may emit radiation through bodily fluids, which can impact others. Precautions include:

• Maintain at least a three-foot distance from people for the first eight hours post-treatment and six feet from pregnant individuals and children.
• Sleep alone and avoid prolonged intimate contact for three to four days, though brief contact like handshaking or hugging is allowed.
• Drink fluids to flush out radiation.
• Sit when urinating and flush twice. Designate a bathroom post-treatment and avoid public restrooms.
• Frequent hand washing.
• Daily bathing or showering.
• Launder clothes, sheets, and towels daily, separately from others' laundry.
• Avoid prolonged food preparation for others.
• Use your dishware and wash separately from others' items.
• Avoid public transportation and long trips in close quarters.

Most providers advise avoiding pregnancy for six to twelve months post-treatment for those assigned female at birth and avoiding conception for at least six months for those assigned male at birth.

How long do you have to stay isolated after radioactive iodine?

Post-RAI therapy isolation ranges from at least three days to two weeks, depending on the radioiodine dose and other factors, with longer isolation generally for thyroid cancer treatment. Your healthcare team will provide specific instructions for your case.

Your healthcare team will go over all these preparation steps in detail. Be sure to follow their instructions, and don’t hesitate to ask questions.

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