Before the RAI therapy, the goal is to prepare the body to take up as much of the iodine as possible. This preparation is done one of two ways:
Thyroid hormone withdrawal:
The patient stops taking thyroid hormone replacement pills for four to six weeks before the treatment. Since there is no thyroid hormone in the body, the brain makes high levels of TSH which "tells" any remaining thyroid tissue to take up iodine to make thyroid hormone. Since the patient is not taking thyroid hormone replacement, they will become hypothyroid and often feel very tired and fatigued by the end of the withdrawal period. Often, they will be given Cytomel which is a short-acting form of thyroid hormone up until 2 weeks before the RAI therapy in order to minimize the amount of time they are hypothyroid. The TSH level should be at least 30 before RAI is given.
Thyrogen is a man-made form of thyroid stimulating hormone that is given as an injection on the 2 days before the RAI therapy. This therapy does not require that the patient become hypothyroid.
Both techniques appear to be equally effective. It is important to discuss with a thyroid specialist which form of preparation is best for the individual patient. In addition, patients should be on a low iodine diet for 2 weeks before the RAI therapy. Information about the low iodine diet can be found at: http://thyca.org/rai.htm#diet
The RAI is removed from the body in the sweat, saliva, and urine. For this reason, patients who are not being hospitalized for the therapy should prepare for the following precautions they will need to follow in the first 5 days after the therapy:
- Avoid close contact (< 3 feet) with young children, elderly, and pregnant women
- Avoid sharing a toilet or bathroom. Flush with the lid down.
- Avoid sharing food.
- Avoid sharing a bed.
- Avoid kissing and sexual activity.
- Wash clothes, towels, and linens separately.
- Wash hands and the rest of the body often.
Your physician can arrange a consultation with New York Thyroid Center radiation safety specialists both prior to your ablation and during treatment. They will discuss your specific needs during the treatment.