Hyperthyroidism is very common and every hyperthyroid patient has to choose between drugs, surgery and isotopes under the guidance of a doctor. Learning and understanding the disease and its treatment can help us to make a correct and rational decision and achieve the best results. The three axes of hyperthyroidism treatment
These three axes are historically tested and universally accepted classical treatments that are more than adequate to deal with most hyperthyroidism. Depending on the individual characteristics of each hyperthyroid patient, the doctor will choose the most appropriate one. Medications and surgery are relatively familiar and easy to understand. (The term “medications” here refers specifically to “antithyroid drugs” such as methimazole and propylthiouracil)
Today, we would like to introduce you to “isotopic iodine” (I-131) treatment for hyperthyroidism.
What is isotopic iodine? To understand isotopic iodine, we can start with two properties.
Elemental iodine: As an isotope of iodine, I-131 enters the body and, like ordinary elemental iodine, is taken up by the body and enriched in the thyroid gland, where it is used to synthesize thyroid hormones.
Isotope: As an isotope, I-131 produces ionizing radiation during decay, mainly beta rays, and a very small amount of gamma rays. Since I-131 is concentrated in the thyroid gland and the range of β-rays is very short, only 0.8mm, almost all of its radiation energy is absorbed by the thyroid tissue, resulting in degeneration and necrosis of thyroid cells.
At the same time, the effect on the surrounding thyroid tissue and other organs is minimal. In this sense, isotope iodine therapy is a “non-invasive thyroidectomy”. The effectiveness and safety of isotope iodine therapy, a treatment for hyperthyroidism that has been available for more than 70 years, has been well established.
Compared to the long course of antithyroid medication, the high rate of side effects and recurrence, and the risk of complications associated with surgery, isotope iodine treatment is considered the treatment of choice for adult (Graves’) hyperthyroidism because of its short duration, high cure rate, and good safety profile. Children (>5 years old) and adolescents with hyperthyroidism may also choose isotope therapy if drug or surgical treatment is ineffective or recurs.
Isotope iodine is particularly suitable for patients with hyperthyroidism if they have the following characteristics.
1. Allergy to “antithyroid drugs” or other adverse drug reactions;
2. Poor efficacy of previous “antithyroid” drugs or multiple relapses;
3. Contraindication to surgery, or high risk of surgery, not suitable for surgical treatment;
4.History of neck surgery or external irradiation;
5. Long duration of hyperthyroidism;
6.Elderly patients, especially those with cardiovascular disease risk;
7, combined with liver function damage;
8, combined with leukocytopenia or thrombocytopenia;
9, combined with heart disease.
Disadvantages and contraindications of isotope therapy Of course, isotope iodine therapy has its shortcomings.
The biggest disadvantage that is unacceptable to many people is that a significant proportion of hyperthyroidism patients will turn into lifelong hypothyroidism after treatment, requiring long-term thyroxine supplementation. “What kind of treatment is it that turns one disease into another and requires lifelong medication?” Many people will have such doubts. In fact, the treatment of hyperthyroidism is complicated and damaging to the organism, while hypothyroidism is easy to diagnose and simple to treat.
Therefore, it is worthwhile to choose the lesser of the two rights, and to replace “hyperthyroidism” with “hypothyroidism”. Of course, the general medical consensus cannot replace individual value judgments, and the specific choice has to be decided by the patients themselves.
If the following characteristics are met, isotope iodine treatment is not suitable.
1. Pregnancy, lactation, or planned pregnancy within the next 6 months;
2. Patients with hyperthyroidism combined with thyroid cancer;
3. Hyperthyroidism combined with moderately severe active ocular pathology.
If you are a patient with hyperthyroidism and are planning or have already chosen isotope iodine therapy, we recommend that you read the following carefully.
Before treatment
A low iodine diet for 1-2 weeks prior to treatment allows the thyroid gland to be “iodine starved”, which promotes more efficient uptake of the therapeutic I-131 into the thyroid tissue.
1. A low iodine diet for 1-2 weeks prior to treatment puts the thyroid gland in a state of “iodine starvation”, which promotes more efficient uptake of therapeutic I-131 into the thyroid tissue.
2. It is recommended that all patients use “beta-adrenergic receptor blockers” such as propranolol, atenolol, metoprolol, etc. prior to treatment, unless there are contraindications to the use of such drugs.
3. If the patient has severe hyperthyroidism, such as very obvious symptoms or thyroxine (FT4) levels exceeding 2-3 times the upper limit of normal, he should be treated with antithyroid drugs (methimazole is preferred) for a period of time and discontinued 3 days before isotope therapy.
4. If the patient is combined with serious underlying pathologies, such as heart disease, infection, liver failure, kidney failure, diabetes mellitus without good control, cerebrovascular disease, pulmonary disease, etc., the corresponding treatment must be given first, and then isotope therapy should be administered after the condition is stabilized.
On the day of treatment
1. Fasting is required for 2 hours before and after the oral administration of I-131, and moderate drinking is allowed.
2. Do not rub the thyroid gland after taking the medication.
3. On the day of treatment, patients with a history of “motion sickness” should avoid riding in motor vehicles to prevent motion sickness and vomiting.
After treatment
1. Take rest and avoid straining and mental stimulation, drink more water and urinate more within 2 days after taking the medicine.
A few patients may experience weakness, nausea, itchy skin, swollen thyroid gland and other symptoms within a few days after treatment, just pay attention to observation and symptomatic treatment. If individual patients have symptoms of thyroid pain, they can be given the necessary pain relief treatment.
3, pay attention to radiation protection after oral I-131 for a period of time, the patient will constitute a small amount of γ radiation to the surrounding near people, but the amount of radiation released in vitro is limited and will not cause a clear radiation hazard. Even so, according to the principle of radiation protection, it is recommended to keep more than 1.8 meters distance from others in fixed residence and avoid sharing utensils with others within 1 week after treatment. Within 2 weeks after treatment, close contact with infants and pregnant women should be avoided; those with childbirth plans should consider conception after six months.
4. In case of aggravation of symptoms, the thyroid hormones in stock in the thyroid tissue will still be released into the blood within 2 weeks after isotope treatment, which may cause aggravation of hyperthyroidism symptoms. In addition to continuing to take “beta-adrenergic receptor blockers” until the symptoms disappear, patients with severe hyperthyroidism can continue to take methimazole orally 3-7 days after isotope treatment and gradually reduce and stop the dosage in the following 4-6 weeks as the thyroid function becomes normal.
5. Insist on review Most patients will gradually have their symptoms relieved and disappear within 4 to 8 weeks after receiving isotope iodine treatment, and the size of the thyroid gland will shrink and return to normal. It is recommended to follow up within 1~3 months and at 6 months after treatment to evaluate the efficacy, and the interval of review can be gradually extended to once a year afterwards.
6.May need to be treated again After 3~6 months of treatment, if hyperthyroidism is still not relieved, isotope treatment can be performed again according to the condition.
7.If hypothyroidism occurs after treatment for hypothyroidism, levothyroxine sodium can be used for treatment, and the dose should be reviewed and adjusted regularly.