Administration of Radioactive Iodine (RAI)
Radioactive iodine treatment is administered by staff in the Nuclear Medicine department of hospitals. Treatment doses are approximately 3.7-5.5 GBq or 100-150 mCi. Physicians usually offer printed instructions to follow after the treatment and they may differ slightly from place to place. As the iodine is radioactive, hospitals must follow specific procedures in administering the treatment. Patients are given the iodine (131) in pill or liquid form. For those given the liquid form, they are asked to drink it through a small straw. Once a treatment dose is administered, you are isolated - sometimes in a special hospital room, to protect others from the radioactivity you will be emitting. Patients receiving a treatment dose of RAI are typically kept in full isolation for 2-3 days. Alternatively, where domestic circumstances permit, some patients are allowed to go home with instructions on self-isolation.
The RAI is tasteless and there is usually no physical reaction - although with high dose treatments (over 5.5 GBq or 150mCi), patients may experience nausea, and in rare cases, vomiting.
Patients who are admitted to hospital remain in an isolation room for one to three days in order for the level of radioactivity to diminish to an acceptable level. Because of the initial relatively high level of radioactivity, visitors are either not permitted or limited in the duration of their visits. You will be in contact with the nursing station usually by telephone, and in some instances nursing staff may check on you for short periods of time, but remaining at an appropriate distance. Food will be delivered to your door. Patients are advised to take frequent showers and remember to drink fluids. Special instructions in regards to bathing and disposing of your waste are usually given. It is often the case that everything stays in the room with you (including food trays and used towels) until you are discharged.
A doctor or technician from the Nuclear Medicine department administers the RAI and returns to your room at the end of the isolation period to measure the degree of radioactivity you are emitting with an instrument similar to a Geiger counter. When the measure is low enough, you are discharged.
Excess radioactive iodine exits the body primarily via urine with lesser amounts leaving in saliva, sweat and faeces. The amount of RAI in your body decreases rapidly and the possibility of harmful radiation exposure to the patient and others decreases quickly after the first few days. The tiny amount of RAI remaining in the body is "absorbed" only by thyroid cells. Over time this small amount of RAI continues to ablate (destroy) remaining normal thyroid tissue and thyroid cancer cells.
Often hospitals are not prepared to provide low iodine meals while patients are in RAI isolation. Therefore, it is a good idea to steer clear of any high iodine foods they may provide (e.g. fish, milk, soy) and/or to bring some appropriate foods from home. Some easy-to-pack and wholesome foods include unsalted nuts, fruits and rice cakes. As the duration of the can vary, check with your doctor to confirm when you start and stop the Low Iodine Diet.
The isolation experience is not painful, but it may be lonely, so it is important to be prepared.
Helpful Hints for Isolation Following RAI Ablation
- As some hospitals do not offer low iodine meals, you may want to take a supply of fruit, juices and LID treats with you.
- RAI treatment may damage the salivary glands. To help minimize this damage, you may be asked to:
- Keep hydrated by drinking water several times during the first night after your RAI treatment
- Suck on hard sour candy or sour fruit to encourage saliva flow. You may want to bring your own supply of sour candies to suck on. Some hospitals will supply you with lemon wedges for the same purpose.
- Salivary gland massage is thought by some to promote drainage of radioactive saliva.
- You may want to bring anti-nausea medication, such as Gravol. If you do take a dose of your own medication, let the nursing staff know.
- Still on this unpleasant topic, you are strongly advised to use the toilet if you need to vomit. Remember, you are producing radioactive waste and it is safest diluted in the sewer system.
- Some hospital guidelines for RAI require that all patients, males included, sit to urinate. You should flush twice and wash your hands thoroughly with soap and plenty of water after using the toilet; then rinse the sink.
- It is suggested that you take showers throughout the day and wash your hair to remove radioactivity from your skin and scalp. Bring small bottles of shampoo, conditioner, skin lotion etc. and leave the containers behind when you leave.
- While you will likely feel lethargic and may not feel like reading or watching TV, you might want to bring a supply of magazines or pocketbooks that can be left behind, if need be, when you leave the isolation room.
Home Isolation
Upon release from hospital isolation, you may be asked to follow some special instructions to continue semi-isolation at home for a few days. This includes keeping a distance from others, especially young children, and pregnant women. You will probably be requested to sleep in a separate bed from your spouse, wash your clothes and bed linens separately, and keep your distance from people (e.g. only sit close to people for short periods of time). As noted above, it is becoming more common for patients to spend their full isolation period at home (i.e. no hospital isolation following the administration of the RAI treatment). This may be possible for those who can have a bedroom completely to themselves for the first three days post-RAI treatment. The nuclear medicine department of your hospital will give you full instructions for this process.
Regular follow-up monitoring with your physician will help detect recurrences early, putting you back on the road to a healthy future.
Disclaimer: The information contained on this website does not constitute medical advice. Visitors are encouraged to work closely with their doctors to make sure that their individual medical needs are met. The Canadian Thyroid Cancer Support Group (Thry'vors) Inc. does not endorse any product, treatment, service or practitioner and is not responsible for the quality of the information or services offered by other organizations or websites.
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