this is my second in a series of blogs about radioactive iodine( I-131), the treatment dose. also known to his friends as RAI. one does not really have a fever after receiving RAI, but you perhaps could think of yourself as being " hot blooded". in this blog, i will give some of the facts, information and so forth about RAI. in my third, and last blog on this subject, i will relate my personal experience with that wild and crazy guy.
so, your thyroid cancer ( usually papillary, follicular, or both) has been shown to benefit from a dose of RAI. this depends on the tumor staging. lower risk patients may just have surgery and not the RAI. higher risk patients will most likely get a dose of the RAI. this dose is expressed in millicuries. the usual range of RAI is between 100 and 200 millicuries, as i stated in my last blog. the treatment dose of RAI is usually given between 3 and 6 weeks after surgery.
to get ready for the RAI, you will need to be on the low iodine diet. since you read my last blog, you realize how important this diet is to your treatment success, so you have followed it religiously. another very important part of preparation before RAI is raising your TSH level. why, do you ask? well, it is important that every remaining thyroid cancer cell be awakened and ready to gobble up the RAI. TSH stimulates the thyroid cancer cells to take up the radioactive iodide cells. the low iodine diet and raising the TSH work together to insure that the RAI is effective in killing the remaining thyroid cancer cells. these thyroid cancer cells may be rogue- in different parts of the body already. or they may be just hanging out in the neck area. either way, to prevent recurrence of the disease, it is important to kill them. i liked to think of the RAI as little jedi knights, complete with light sabers. i will expand on this in the next blog, when i talk about my own experience.
there are two different ways to raise the TSH. one is brutal- the patient has to be off thyroid medication for 3 to 6 weeks. this is brutal because most people do not want to be without thyroid medication. ask any hypothyroid patient how they feel without their medication and they will definitely explain the mental fog, fatigue, body aches, etc, associated with a high TSH. there is another way to raise the TSH, thankfully. the TSH can be raised quickly with Thyrogen injections. it is a series of injections given a few days before the RAI is given. both methods are considered equally effective. my doctor recommended the Thyrogen injections for me- i was still working ( up to the actual RAI dose) and it would have been impossible for me to do my job with brain fog. i was very fortunate that my insurance company covered this medication- some do not.
unfortunately for me, i could not get my doctor to prescribe anti-nausea medication prior to me receiving the RAI. some doctors will routinely do this, but my doctor did not. i did have pretty much nausea after receiving the RAI, but i did not actually vomit, thank goodness. the nausea only lasted about a day or so. if you are prone to nausea, as i am, i would recommend at least asking your doctor for some anti-emetics, if they do not routinely prescribe them.
some people stay in the hospital after the RAI is administered. some people go home- as i did. it depends on many factors. who is sharing your home( small children, pregnant women,etc), how your home is constructed- do you have an area, say an upstairs part, that you can be isolated in? the time of isolation varies. your physician will tell you the length of time that you need to be isolated. you will still be on the low iodine diet for a while during RAI and for some period of time after treatment. it takes a while,it could be months, for those little jedi knights to get to all of the thyroid cancer cells.
between 2 and 10 days after the RAI treatment dose, you will have a whole body scan. getting to the hospital for this can be very tricky. you need to stay at least 3 to 6 feet away from people, especially children and pregnant women, for at least 8 days. you also need to keep a safe distance from your pets. most radiation from the RAI,( although radiation detectors at airports,etc, can detect small amounts of radiation for up to three weeks), is gone in about a week. your physician may have specific instructions about the amount of time you need to be isolated. please be sure to follow these instructions. you do not want to expose anyone unnecessarily.
another good tip, which i did not read about until after my RAI, is that it is a very good idea to get a good dental cleaning prior to treatment. the RAI affects the acidity of the saliva, and can also cause dry mouth. dry mouth can lead to dental issues, i.e. tooth decay. it is also recommended that harsh toothpastes and mouth wash be replaced with sensitive toothpastes, or better yet, baking soda. brushing your teeth with baking soda, several times a day, and flossing is very important. the RAI can cause a metallic taste for some, so the frequent brushing with baking soda may help with this issue as well.
i have just mentioned a few basic facts, tips and precautions associated with a treatment dose of RAI. every one's situation is different. your physician may recommend other tips and precautions that would be more helpful for your situation. be sure to have a clear understanding of what you need to do to help keep yourself and others safe during the RAI. a treatment dose of RAI should not be physically painful, but being in isolation is difficult. it is emotionally draining. i wanted a big hug from my husband, but of course that was not possible for a while. i will admit that i was lonely during this time of isolation. i had paperback books and magazines to read ( i disposed of them afterwards) and i could come downstairs and watch TV when my husband was at work. i had to wear disposable gloves and sit on a piece of plastic on the couch. for more of my adventures of RAI story, please stay tuned for the next blog...
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