Iodine treatment, the old Bush regained life after the U.S.-Iraq “desert war”, the United States President Bush Sr. on leave at Camp David found himself in a part of the body problems. He felt panic attacks, weakness and hand tremors, and was troubled by them. “I often wonder if George Bush was healthy during the campaign. Bush was healthy during the campaign.” Powell, then chairman of the Joint Chiefs of Staff, recalled in “My American Way. In 1991, Bush fainted from an irregular heartbeat while jogging at Camp David, although few people knew about it at the time. 1992, Bush Sr. visited Japan and felt ill at a state dinner in Tokyo, and vomited up before he could go to the bathroom. Bush Sr. finally fainted and lasted about three minutes before waking up. The whole process was shown to the world by the live television broadcast. The U.S. government rushed him home and diagnosed that Bush was suffering from a thyroid disease called Graves’ disease. Bush’s wife, Barbara, has also suffered from hyperthyroidism for many years. Doctors say the chances of a couple suffering from this disease together are only 1 in 200,000. After the fainting incident, many world-class medical experts consulted and discussed the case, and finally decided to treat the Bush couple with the isotope 131 iodine, and three months later, the Bush couple quickly recovered. The only price Bush paid was that he did not hold his young grandson for a week after taking the drug (this is a precaution after taking the isotope). The elder Bush’s successful cure of hyperthyroidism with isotopes was once again a worldwide sensation. Although he lost the election, he was given a new lease of life in his later years. It was indeed astonishing to see how strong Bush’s physique was after the treatment, even more than back then. on March 25, 1997, Bush Sr. in his 70s made a successful high altitude parachute jump over the great desert of Arizona, USA. Bush jumped from a height of more than 3,800 meters, and when there were still 1,300 meters from the ground, he opened his rainbow-colored parachute and floated down. on June 13, 2004, the old Bush, who was already 80 years old, jumped again from a height of 13,000 feet in Houston, Texas, to celebrate his birthday. Viewers around the world witnessed his feat on TV. Even Bush’s old rival Clinton also teased that the old Bush, who is already in his 80s, is in better health than his 60-year-old self, and perhaps the old Bush will be able to attend his funeral and deliver a speech in the future. Yu Fei, Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Shanghai Hyperthyroidism: Iodine 131 in Nuclear Technology Many people know that atomic bombs and hydrogen bombs are a kind of nuclear weapons with great lethality, which is the application of radionuclides and nuclear technology in military, but they do not know much about the application of nuclear technology in medicine. In recent years, with the development of science and technology and the improvement of people’s cultural quality, the awareness of radionuclide therapy work has gradually increased, but it is not deep and comprehensive. For example, radioactive iodine treatment for hyperthyroidism is an effective treatment method, which is simple, safe, with high one-time cure rate, low recurrence rate and low cost, so it is welcomed by patients. Hyperthyroidism (short for hyperthyroidism) is a very common endocrine disease, which is a combination of increased metabolic rate due to excessive secretion of thyroid hormones. It has many causes. The pathology is diffuse, nodular or mixed goiter and a variety of organ and tissue lesions caused by hyperthyroidism, including a series of pathophysiological changes that occur due to excessive thyroid hormones acting on various organs throughout the body. Patients with hyperthyroidism may experience some conscious symptoms, such as panic, rapid heartbeat, fear of heat, excessive sweating, irritability, fatigue, weight loss, hyperphagia, increased stool, etc. Some patients may also find themselves with thickened neck and protruding eyeballs. If the above symptoms and signs appear, it is likely that the patient is suffering from hyperthyroidism and should go to the hospital for relevant examinations in time to make a clear diagnosis. In hospitals, doctors usually arrange for serum T3, T4 (including TT3, TT4, FT3, FT4) and thyroid stimulating hormone (TSH) tests according to the patient’s symptoms, as well as thyroid scans to understand the shape, location, size, nodules and function of the thyroid gland. diffuse enlargement or toxic thyroid adenoma. The diagnosis of hyperthyroidism is basically confirmed. If the serum T3 and T4 levels are not significantly increased, further iodine uptake rate of the thyroid gland and thyroxine suppression test and thyroid hormone releasing hormone (TRH) excitation test can be done, which are helpful in the diagnosis of atypical hyperthyroidism. Patients suffering from hyperthyroidism need not panic, as the disease is completely curable with the development of medical science today. However, unlike a cold or flu, it will not be cured in a few days and there is a process. As long as you listen to the doctor’s advice and take regular medication, it is not difficult to cure. At present, there are four kinds of treatment methods in common use: internal anti-hyperthyroidism medication, surgery, radioactive iodine treatment and traditional Chinese medicine. Internal treatment refers to the use of anti-thyroid drugs, such as tabazol, hyperthyroidism, methylthioxypyrimethamine, propylthioxypyrimethamine, etc., which mainly play the role of inhibiting the synthesis of thyroid hormones. This is a commonly used method with positive efficacy and easy method. The disadvantage of this method is the long treatment time, at least one year of regular medication, and the high relapse rate (up to 50%) after stopping the medication, and some patients may have allergic reaction, leukopenia, or liver function damage. Surgery is also a treatment method for hyperthyroidism, especially for toxic thyroid adenomas. If the adenoma is removed cleanly, there is usually no recurrence of hyperthyroidism in the future. However, after all, it is a surgical procedure with certain risks and a high recurrence rate (30%), and there is also a risk of hypothyroidism, especially in diffusely enlarged hyperthyroidism. According to the theory of Chinese medicine, hyperthyroidism is caused by internal injuries and the seven emotions of the heart, liver and yin deficiency and fire, and dialectical treatment is also effective, but the course of this disease is long and long-term decoction of Chinese medicine is not very practical, and some results are also poor. Treatment with radioactive iodine is currently recognized as an effective method worldwide. Currently, it is included as the preferred method in some Western countries. Why is isotope therapy so effective? Because iodine is a necessary raw material for the synthesis of thyroid hormones in the thyroid gland, and radioactive iodine has the same physiological and biochemical properties as stable iodine, so the thyroid tissue also has a high absorption and concentration capacity for radioactive iodine. In general, the concentration of iodine in the thyroid gland can reach 25 times of the plasma concentration. In patients with hyperthyroidism, the rate and amount of synthesis of thyroid hormones increase, so the concentration of radioactive iodine is even higher, up to 80-90%. The effective half-life of iodine in the thyroid gland is 3.5 to 4.5 days on average. The large amount of concentrated radioactive iodine exposes the thyroid gland to radiation, and part of the thyroid tissue is destroyed, resulting in a decrease in thyroid hormone production and remission or cure of hyperthyroidism. Iodine-131 is an unstable radioactive radionuclide that emits γ and β rays during the decay process, with β rays accounting for 99% of the therapeutic effect. Because beta rays have a short range of 1 mm on average and 2.2 mm on the longest, they can destroy thyroid tissues but have little or no effect on the tissues and organs around the thyroid. This shows that radioactive iodine is a safe and easy way to treat hyperthyroidism. Who is suitable for radioactive iodine therapy? It is generally accepted that iodine-131 therapy is suitable for adult patients of both sexes. It is the treatment of adolescents and children that is being debated. A long time ago, there were concerns about the risk of cancer and leukemia and congenital abnormalities in the fetus with iodine-131. After half a century of clinical practice these fears have been eliminated. Statistics on more than 1 million patients at home and abroad show no increase in the incidence of leukemia and thyroid malignancies, no more than natural incidence of fetal malformations, and no effect on fertility and offspring development. These have been extensively reported in the literature. The current expert consensus is that hyperthyroidism during pregnancy and lactation should not be treated with iodine-131 because it can cause hypothyroidism in the fetus or infant. Therefore, we believe that iodine-131 is a safe form of treatment for patients of all ages (including women of childbearing age and children), except for pregnant and lactating women, and can be the treatment of choice for adults. Treatment of hyperthyroidism with radioactive iodine is usually performed in a nuclear medicine department. The nuclear medicine doctor decides the timing and dosage of radioactive iodine based on a comprehensive analysis of the patient’s hyperthyroidism symptoms, clinical manifestations, laboratory test results, thyroid gland iodine absorption function and thyroid scan results. Generally speaking, after the diagnosis of hyperthyroidism is confirmed, some preparatory work should be done before treatment with iodine-131, such as controlling certain heavier complications and abstaining from iodine-containing foods or medications. Before and after taking iodine-131, some auxiliary therapeutic agents should be dispensed according to clinical manifestations, and certain reactions should be noted some time after taking the drug. Most of the patients can be controlled after treatment, and a cure can be achieved with a single dose of the drug. A small number of patients require a second treatment. The effect of iodine-131 starts to appear more than 3 weeks after taking it, and within 3 months the symptoms gradually improve, the thyroid gland shrinks and some patients’ proptosis is reduced. 6 months to 2 years the symptoms are completely eliminated. For those who need a second treatment, it should be done after six months. Some patients with hyperthyroidism have protruding eyes, which is called proptosis. The causes are complex and may be related to certain immune disorders in the body, and some people have found that there is a substance in the serum of these patients that is related to the occurrence of proptosis. The occurrence and aggravation of proptosis are not parallel to the condition of hyperthyroidism. Most patients with hyperthyroidism will not have their proptosis aggravated by iodine-131 treatment, but only a few cases may have their proptosis aggravated. This should be properly understood. Hyperthyroid patients generally do not have any reaction after taking iodine-131, and only a few patients experience some side effects. Some reactions that occur within 2 weeks after taking the drug are called early reactions, mainly nausea, vomiting, dizziness, weakness, and in a few patients, rash and itching, which are generally mild and can disappear on their own. Some patients may experience transient exacerbation of hyperthyroidism, which is usually temporary, and very few patients with severe symptoms have to be hospitalized for observation. The main complication in the late stage is hypothyroidism (also known as hypothyroidism). It is caused by insufficient synthesis and secretion or physiological effect of thyroid hormones. One type of hypothyroidism caused by iodine-131 treatment is transient hypothyroidism, which is mild and can disappear on its own after 6 to 9 months because of the recovery of incomplete thyroid cells damaged by radioactivity or the compensatory proliferation of residual tissues. The other is permanent hypothyroidism, the incidence of which is reported to be 2-5% in the first year, and increases by 2-3% year by year as time goes on. Low thyroid is not terrible, as long as the right amount of thyroxine is supplemented, you can maintain normal thyroid function. Some scholars believe that hypothyroidism is a natural history of hyperthyroidism, which can occur after various treatments and is not unique to iodine-131 treatment. In summary, several methods of treating hyperthyroidism have their own characteristics, and it is necessary to develop the correct treatment plan for the individual patient. In contrast, radioactive iodine-131 treatment for hyperthyroidism is widely applicable, simple, safe and effective, with few doses, few complications, high cure rate and low cost, and can be the first choice for most patients. Precautions for iodine treatment 1. Radioactive iodine treatment for hyperthyroidism is usually performed in the outpatient department of nuclear medicine and does not require hospitalization. 2. Taking radioactive iodine must be done under the guidance of a nuclear medicine doctor, and the drug must not be taken away and cannot be mailed. 3. Before and after receiving radioactive iodine treatment, it is recommended to eat light and nutritious food, and to eat less seafood and iodine-containing food. 4.Young women with hyperthyroidism who receive radioactive iodine treatment can generally become pregnant six months after healing. 5.You do not need to take radioactive iodine if you have a history of hyperthyroidism, but you have improved after treatment, and you are asymptomatic and have normal laboratory tests. 6. Giant goiter without hyperthyroidism can also receive radioactive iodine treatment.