Author: Dr. Segkos
Each patient is different, and they should be treated no other way! We
have seen tremendous progress in the field of thyroid cancer. Nowadays,
we have a much better understanding of this disease, and we can tailor
the treatment to every patient’s needs, something that is called
personalized medicine. This also applies to radioactive iodine treatment.
The latest American Thyroid Association thyroid cancer guidelines have
a really good risk stratification system. In order to find out what is
the risk of having the cancer come back, we take into account the labs
and ultrasound before and after surgery, the surgeon’s impression,
the detailed report of how the thyroid cancer looks under the microscope,
and any other data available. We combine this information to categorize
each cancer as low, intermediate, and high risk.
In the past, radioactive iodine used to be given much more frequently and
at much higher doses, even for low risk cancers. However, as we understand
thyroid cancer better, we have found that radioactive iodine is not needed
for low risk cancers, as it is not going to change the chances of having
the cancer show up again in the neck, or travel to distant parts of the
body. Also, in these low risk cancers, it does not improve survival (except
in special occasions), which is already excellent. When our patient does
need it, most of the time the dose that should be given is lower than
what we would have given 10 years ago.
But why is it important to try to avoid radioactive iodine when it is not
necessary? As with any other medication, radioactive iodine can have complications.
These complications are dependent on the dose of radioactive iodine given,
and can have an impact on the quality of life. The patient can develop
dry mouth and dry eyes and feel changes in how foods taste, as the radioactive
iodine can damage the tear and saliva making glands. These glands can
occasionally become painful for a few weeks after the treatment. Less
commonly, these complications can stay for a long time. At very high doses,
generally more than 200 mCi of radioactive iodine, if the prescribing
doctor is not careful the patient may get complications in the kidneys,
lungs or bone marrow. Lastly, there is a very slight increase in the risk
of other cancers, although this increase in risk is very small and additional
screening for other cancers is not needed after radioactive iodine.
Here, at the Thyroid Institute of Utah, our thyroid experts are up-to-date
with the latest research and guidelines. We provide evidence-based recommendations
and tailor the thyroid cancer treatment after taking into account every
aspect of YOUR cancer. We make sure that we give radioactive iodine at
the right dose when it is needed, and that you will not receive radioactive
iodine when you don’t need it.
Make sure you get a second opinion prior to receiving a higher dose of
radioactive iodine, or if your doctor does not plan on giving you radioactive
iodine for a higher risk cancer.