The difference between radiation therapy and radioactive iodine therapy.

I am finding that a great deal of people think I am going through radiation therapy for my thyroid cancer. That is not the case. I was administered a radioactive iodine pill to help kill any of the thyroid that may still exist in my body. Let me try to explain the difference. My therapy is referred to as systemic radiation therapy.

Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. The radiation may be delivered by a machine outside the body (external-beam radiation therapy). External-beam radiation therapy is most often delivered in the form of photon beams (either x-rays or gamma rays). A photon is the basic unit of light and other forms of electromagnetic radiation. It can be thought of as a bundle of energy. The amount of energy in a photon can vary. For example, the photons in gamma rays have the highest energy, followed by the photons in x-rays. Patients usually receive external-beam radiation therapy in daily treatment sessions over the course of several weeks.

Radiation therapy may come from radioactive material placed in the body near cancer cells (internal radiation therapy, also called brachytherapy. Internal radiation therapy is radiation delivered from radiation sources (radioactive materials) placed inside or on the body. Several brachytherapy techniques are used in cancer treatment. Interstitial brachytherapy uses a radiation source placed within tumor tissue, such as within a prostate tumor. Intracavitary brachytherapy uses a source placed within a surgical cavity or a body cavity, such as the chest cavity, near a tumor. In brachytherapy, radioactive isotopes are sealed in tiny pellets or “seeds.” These seeds are placed in patients using delivery devices, such as needles, catheters, or some other type of carrier. As the isotopes decay naturally, they give off radiation that damages nearby cancer cells. If left in place, after a few weeks or months, the isotopes decay completely and no longer give off radiation. The seeds will not cause harm if they are left in the body. Brachytherapy may be able to deliver higher doses of radiation to some cancers than external-beam radiation therapy while causing less damage to normal tissue.

In systemic radiation therapy, a patient swallows or receives an injection of a radioactive substance, such as radioactive iodine or a radioactive substance bound to a monoclonal antibody. Radioactive iodine -131, is a type of systemic radiation therapy commonly used to help treat some types of thyroid cancer. Thyroid cells naturally take up radioactive iodine.




 

Radioactive!!!

Now that I have your attention. :)

You must be wondering what I am talking about.

  

Radioactive iodine treatment.   (RAI)

Don't worry: Glowing in the dark is not one of the radioactive iodine treatment side effects. Even though that would be pretty cool!

This is all going to sound crazy!!

Here goes-------->

I have talked to a lady, who is a nurse, who went through the RAI recently. I will tell you what she has told me to expect. Then I will put the information that my doctor gave me.

I will be given the pill at the hospital. In a closed room, where the doctor and nurse are the only other people in the room with me. The nurse will bring the pill in a metal container. She will open it and pour the pill in my hand. I will take it with water, lots of water. I will not be able to drive myself home since I will not know how the iodine will affect me. Some people have severe vomiting or diarrhea. But I will have to sit as far as I can away from Tim. I will be in the back seat on the passenger’s side. Once I get home I will have to go to my room where I will stay, by myself, for the next 7 - 10 days. Quarantine or isolation. Call it what you want. It is going to really suck!  

When I need to eat, someone will have to bring it to my closed door. They will put it on the table outside my room, knock on my door and head back down the hallway. (Staying at least 6 feet away.) I will then be allowed to open the door to get the food, then close the door quickly. I will eat with disposable plates, cups and silverware.

I will need to shower 2 - 3 times a day. This will help wash away the radiation. When I use the bathroom, I will need to close the lid and flush 3 times. Washing my hands must be done for 5 minutes.

My clothes will need to be changed each time I shower. I will need to use a clean towel each time. I am going to change my sheets daily. You are most likely thinking that this sounds inconvenient, but do-able. Here is the fun part. I am not supposed to wash my clothes, any bedding or towels for 2 weeks. I am going to put them in a bag and wait to wash them until the radioactivity is down to a safe level.

I will have my phone and computer. I figure I will be watching lots of TV and reading quite a bit. I do want to get a cross-stitch pattern to work on during that time.

I will go stir crazy!! My room and bathroom will be spotless by time my quarantine is over.

My 2 dogs and cat will have to be boarded somewhere away from home. The radiation can affect them too.

***********************************************

2 weeks before receiving RAI therapy, a special diet is required. My doctor will provide me with specifics, but a few general items to avoid include:

•  Seafood

•  Processed food

•  Iodized salt

•  Dairy
•  Chocolate
•  Bacon
•  Ham
•  Any foods with iodine
•  No vitamin pills or drugs with iodine

I-131 is an isotope of iodine. An isotope is a variation of an element. In this case, iodine has been altered, making the nucleus unstable. This causes it to emit radiation.

Although everyone dislikes the thought of any radiation, radioiodine therapy is a common medical procedure that is used to treat papillary or follicular thyroid cancer. This treatment will destroy cancerous thyroid cells, along with normal thyroid cells, that remained in the body after a near-total or total thyroidectomy or if the thyroid cancer had spread to other body parts.

I-131 can be taken in a capsule form and will enter the blood stream. The thyroid gland, which needs iodine to make thyroid hormone, takes up the radioactive iodine out of the blood.

Thyroid cells -- even those cancerous thyroid cells that may have spread throughout the body -- absorb the radioactive I-131 substance. The radioactive material destroys them -- ablates them.

Radioiodide emits beta radiation and gamma radiation.

The beta radiation is what destroys the thyroid tissue. It does the work in this medical procedure.

Beta radiation only leaves the body through touch or through body secretions -- such as mucus, saliva, urine, perspiration, and stool.

In general for the first week or so, touching your loved ones or touching a surface that your loved ones may touch -- such as a shower, sink, or toilet -- can cause the beta radiation to be absorbed by them.

Because you don't want to expose them to I-131, which will then travel to their thyroid and destroy a little bit of it, you will want to follow a few guidelines, which are listed below. The same is true about body secretions. They need to be kept in the waste-stream.

Gamma radiation is the raying radiation and will come out of the body. This means that close contact with adults should be limited. You should stay about 10 feet away the day after treatment and about 6 feet away for at least a week to 10 days.

Your doctor will give you an individual timeline because he/she will know how much I-131 you received and how long it will take to pass through your urine and perspiration.

No public appearances during that time, either!

After radioiodine treatment, most of the material will be eliminated from your body through urine in a few days.

As mentioned, the amount of time it takes will depend on the amount of I-131 received, and your doctor will provide individualized guidelines for you.

In general, though, your radiation exposure will be low, will fall off rapidly, and will fall off with distance.

A few precautions, which you still should ask your doctor about, include:

·         On the ride home from therapy, sit as far away from the driver as possible -- i.e., in the passenger's side of the backseat.

·         Stay at home. Now's not the time to go to the movies, work, school, etc.

·         Drink a lot of fluids, which is said to lower radiation exposure to your bladder.

·         Some doctors recommend sucking on sour candy, which can help bring the radioactive iodine out in your saliva.

 What to expect after radioactive iodine therapy

·       Adults should stay about 6 feet away from the treated person

·         Avoid children and pregnant women like the plague for a week

·         No smooching, no sex

·         Don't sleep in the same room as your partner

·         Don't share linens -- i.e., towels, washcloths, bed sheets

·         Wash those linens and personal clothing separately

·         Wash your hands with soap after a potty break

·         Flush the toilet, with the lid down, 3 times after use (and keep it and the area around it super clean)

·         Men need to sit down when urinating to keep splashing minimal

·         Wash sinks and tubs thoroughly after each use

·         Take 2 or more showers a day

·         Use disposable eating utensils

·         Please be sure to understand and ask your doctor and/or treatment center questions about what you can and can't do after radiation exposure.

 

Although your dose may be low, it is not a good idea to expose loved ones when they don't need to be.

After RAI Treatment:

Radioactive iodine 131 side effects

Short-term side effects are minimal. They can include:

·         A tender neck

·         Nausea

·         Upset stomach

·         Swollen and tender salivary glands

·         Dry mouth, metallic taste in mouth

·         Sore throat

·         Fatigue

·         Taste changes

·         Pain

·         Constipation or diarrhea.

The long-term effects of radiation therapy include a shrunken or nonexistent thyroid gland. This will cause hypothyroidism, which is an under-active or not active thyroid. Hypothyroidism is a medical condition that requires daily thyroid hormone replacement medication.

Also, years after treatment, a minute number of patients develop a second cancer.

Despite all the radiation safety needed with I-131 exposure, these precautions will keep your loved ones and the public safe.

Being holed up may seem worse than any radioactive iodine treatment side effects!

After surgery - Hypothyroidism

It has been 8 days since my thyroid cancer surgery. I am feeling good most days. My scar is now starting to itch.

That is not fun at all. The doctor said I am doing pretty well. He said I should expect to get very tired and gain weight.

I have already gained 5 pounds since last week. The doctor said that most everything I eat right now will make me gain weight. SIGH!!!

~~Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain important hormones. the main purpose of thyroid hormone is to "run the body's metabolism," it is understandable that people with this condition will have symptoms associated with a slow metabolism.

Hypothyroidism can cause many different symptoms, such as:

• Feeling tired, weak.
• Depressed.
• Dry skin and brittle nails.
• Not being able to stand the cold.
• Memory problems or having trouble thinking clearly.
• Heavy or irregular menstrual periods.
• Weight gain or increased difficulty losing weight
• Raise your cholesterol levels.
• More likely to have a heart attack. 
• Coarse, dry hair.
• Dry, rough pale skin.
• Hair loss.
• Muscle cramps and frequent muscle aches.
• Constipation.
• Irritability.
• Decreased libido.
  

So those are some of the things I am dealing with. I have had many of the symptoms for a while. I guess I didn't realize my thyroid controlled so many things. Please remember to stick your neck out and check for any lumps or strange bumps!!!

Surgery

Tuesday morning I was at the hospital in Casper, waiting to have my total thyroidectomy. Beth and Justin were with me. Dr. Anderson said the surgery would take about an hour. I remember talking to the anesthesiologist for a few minutes. And then the next thing I knew, I was being wheeled into my post-surgery room. I woke up to Justin's smiling face. I felt a bit loopy for about an hour.

The surgery went smoothly. Dr. Anderson said that all the cancer has been removed. He checked my lymph nodes and they were healthy. I did have a breathing tube put in my throat during surgery. The outside of my throat was a little sore. But the real pain was inside my throat. It felt like acid has been poured down my esophagus. Swallowing hurts. My wonderful nurses brought me hot herbal tea and beef broth. The hot liquid helped a bit.

 

My voice is a little scratchy. All in all things went very smoothly.  I stayed in the hospital until this morning around 11:00. My scar is about 3 inches across. It is bruising and very swollen. Hopefully in a few days it will look and feel better.

Blue, pink and teal!!!

 

Back in May of 2012, my doctor found a cyst on the left side of my thyroid. The cyst measured 2.3 cm. After having an ultrasound the doctor decided I needed a fine needle biopsy. The needle was popped into the cyst and it filled with green fluid. The doctor and I joked that I was part alien. The biopsy was inconclusive. The doctor said that he found abnormal cells, but that is was not cancer. He advised me to have the cyst drained and tested monthly. It that point I didn't have insurance so that was totally out of the question. In late February of 2013, I once again had insurance. I went to the doctor to just have a physical and I thought it would be a good idea to have the cyst removed. My doctor said the cyst felt like it was bigger than it had been a year ago. I needed to have ultrasound done again. A few weeks later Tim and I were both laid off from Uranerz, the uranium mine where we worked. Well you guessed it.... no insurance again. Tim started working for Union Pacific in June and our insurance went into effect in September. Once again I went to the doctor to have the cyst checked. In late October I was sent to Rawlins for another ultrasound. The ultrasound came back showing that the cyst had grown to over 11 cm. and was putting pressure and starting to wrap around my vocal cords. It would need to be removed. On November 4, I had my surgery consultation in Casper. My surgeon said that the big concern he had was the nodule they saw on the cyst on my thyroid. Tim and I both said, "what??" At that point he said "did your primary physician not tell you that you have a solid nodule on your cyst?" Well, she hadn't. So it came as a shock. He sent me over to the hospital for another fine needle biopsy. After almost an hour of being poked in the neck, the biopsy was done. The doctor said I should get the results in a couple of days. On Wednesday 11-6-13, I got a call from the surgeon. He said the results were back and of great concern. No easy way of telling someone they have cancer. I am not really sure what he said after that, except that surgery is scheduled for Tuesday.

 

 

Cancer was not a word that I was ready to hear. I know cancer does not care how old you are. But I still feel like I am too young to have cancer. 43 is still young!! After the shock wore off, the tears came. I called Tim and told him.  Bless his heart, he sweetly said we would get through this together. I am so grateful for my amazing husband. I called other family and friends after a little while. They are all very supportive, but no one really knows what to say.
 

I will be heading to Casper in the morning to have my pre-surgery labs and EKG. Surgery to remove my entire thyroid, the cyst and the nodule will be done on Tuesday. I will stay in the hospital until Wednesday. The doctor said he wants me to stay over night to make sure there are no complications.
 

It sounds like thyroid cancer is very treatable in most cases. The after care will be done with radioactive iodine. ~~~~ Radioactive iodine is also used if you have your thyroid removed (thyroidectomy) because of thyroid cancer. Radioactive iodine therapy destroys any remaining thyroid tissue or cancer cells that were not removed during surgery.

I will have a scar on my throat. It can be any size from about 1.5 inches to 4 inches.
You hear a lot about PINK ribbons for cancer. Not all ribbons are pink. Thyroid cancer's ribbon is blue, pink and teal. I shall get a ribbon.
 

Please stick your neck out and feel for any lumps. Have your thyroid checked each time you go in for your yearly exam. ~~ The thyroid gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body should be to other hormones.