From anxiety to peace of mind: Demystifying the mystery of "iodine-131 treatment" after surgery for differentiated thyroid cancer

In the busy hospital corridor, a middle-aged man hurriedly walked in, holding a consultation form tightly in his hand. His face was full of anxiety and confusion. He came to the outpatient department of the nuclear medicine department and asked anxiously: "Doctor, please help me. Yesterday morning, my wife completed a thyroidectomy for thyroid cancer. I originally thought that she could be like the other two patients in the ward, and she would only need regular checkups after the surgery. But the doctor told me that she still needs iodine-131 treatment. What is going on?"

I asked him to sit down and calmed him down, then I carefully examined the surgical pathology results in his hand, which showed papillary carcinoma in both lobes of the thyroid gland and at least five metastatic lymph nodes.

I continued to explain to him: "Although most patients have good initial treatment effects, about 30% of patients may experience recurrence or metastasis after treatment. Although your wife has completed thyroidectomy, pathological examination found that cancer cells have spread to the lymph nodes. In this case, surgical resection is not the final treatment." According to the guidelines for the treatment of differentiated thyroid cancer with iodine-131 (Figure 1) , we need to use the radioactive isotope iodine-131 for further treatment to reduce the risk of recurrence. Although your wife's risk of recurrence is moderate and she needs iodine-131 treatment, thyroid cancer itself has a good prognosis and is called "lazy cancer", "happy cancer" and "the most gentle cancer" by many people.

Figure 1

After listening to my explanation, his brows were still furrowed, but his eyes showed a little more understanding. He continued to ask: "Why can iodine-131 therapy treat differentiated thyroid cancer?"

I explained in detail: "The principle of iodine-131 in treating thyroid cancer is that iodine-131 can release beta rays, which can destroy thyroid tissue and thyroid cancer cells that can absorb iodine-131, thereby achieving the purpose of treatment. The beta rays emitted by iodine-131 have a range of only a few millimeters, and radiation damage is mainly limited to the thyroid/lesion tissue, with little effect on surrounding tissues . During treatment, patients usually take iodine-131 orally."

After hearing this, he seemed somewhat relieved, but also a little worried: "Then doctor, before this treatment, does my wife need to make any preparations? What do we need to pay attention to?"

I replied: "Before iodine-131 treatment, you are required to follow a low-iodine diet and stop taking levothyroxine tablets for 2 to 4 weeks to enhance the therapeutic effect of iodine-131. Don't worry, we will guide the use of Euthyrox based on the duration of your iodine-131 treatment. In addition, you should avoid enhanced CT examinations at least one month before iodine-131 treatment."

After hearing this, he continued to ask: "How many times do you need to do iodine-131 treatment?"

I explained: "Because the risk of recurrence and the response to treatment drugs vary from patient to patient, the number of iodine treatments required varies. Therefore, the doctor may decide whether to perform multiple treatments based on the patient's condition."

He nodded to show his understanding. "Doctor, I would also like to ask, how long after treatment can I prepare for pregnancy?"

I smiled and replied, "Women are advised to avoid pregnancy within 6 months after iodine treatment."

Hearing this, he finally showed a trace of relief: "Hearing what you said, I feel much more at ease. So after the treatment, should our family also pay attention to something?"

I nodded and said, "Yes, there are some precautions after the treatment. After iodine-131 treatment, the patient will be exposed to radioactive ionizing radiation for a short period of time, so contact with other people should be reduced, especially pregnant women and infants. At the same time, patients need to pay attention to rest, avoid excessive fatigue, and drink plenty of water to help iodine-131 be excreted from the body as soon as possible."

The man finally left the consultation room with peace of mind. He finally understood the importance and role of iodine-131 treatment. He decided to take good care of his wife and follow the doctor's advice on preparation and precautions.

Although differentiated thyroid cancer sounds scary, it is a disease with a relatively good prognosis. Through surgery, iodine-131 treatment and regular follow-up, most patients can achieve good treatment results and return to a healthy life. At every stage of treatment, patients and their families may have doubts and concerns, but believing in science, following doctor's advice, and actively cooperating with treatment are the keys to defeating the disease. Remember, you are not facing it alone. Medical advances and doctors' expertise will always be by your side to help you through this journey.

Author: Liu Shan

First review: Xiong Xiaoliang

Final judge: Zhao Yinlong