Preparing for outpatient radioactive iodine therapy can bring up many questions. If you’re scheduled for this treatment at carcodepro.com, it’s natural to feel a bit uncertain about what to expect. This guide will walk you through the process, from pre-treatment preparations to post-treatment care, ensuring you are well-informed every step of the way. One common question that might arise, especially with concerns about radiation, is: “Should you cover your thyroid during a car scan?” While the term “car scan” might be misleading, it’s important to understand the role of scans in your radioactive iodine therapy and how radiation safety is handled. This article will clarify the types of scans involved in your treatment and address your concerns about radiation exposure and thyroid protection in this context.
Understanding Radioactive Iodine Treatment
Radioactive iodine (RAI) therapy is a crucial treatment, especially after surgery for thyroid cancer. It significantly reduces the risk of cancer recurrence and is also effective in treating thyroid cancer that has spread to other parts of the body.
The treatment typically involves radioactive iodine in pill form, though a liquid form is available if you have difficulty swallowing pills. If you prefer the liquid option, it’s important to discuss this with your doctor at the Molecular Imaging and Therapy Service (MITS), sometimes also referred to as the Nuclear Medicine service, before your treatment begins.
When you ingest radioactive iodine, it enters your bloodstream and is selectively absorbed by thyroid cells. The radiation emitted by the iodine then targets and destroys cancer cells in the thyroid gland and any thyroid cancer cells that may have spread elsewhere in your body.
Radioactive iodine is often administered in pill form for thyroid cancer treatment.
Preparing for Your Radioactive Iodine Treatment
The Low-Iodine Diet: Optimizing Treatment Effectiveness
A low-iodine diet is a critical component of preparing for radioactive iodine therapy. You’ll need to adhere to this diet for at least one week before starting treatment. This dietary restriction enhances the effectiveness of the therapy by ensuring that thyroid cells are “iodine-hungry” and will readily absorb the radioactive iodine. Excess iodine from your diet can saturate thyroid cells, reducing their uptake of the radioactive iodine and potentially diminishing the treatment’s impact.
Continue the low-iodine diet for 24 hours after your treatment concludes, or as specifically instructed by your doctor. For detailed guidance on this diet, refer to resources like “Low-Iodine Diet.”
Your Personalized Treatment Plan: A Step-by-Step Approach
Your doctor will outline a detailed treatment plan, typically spanning several days, designed to optimize your therapy. This plan includes several key steps:
Day 1: Initial Preparations
The first day involves blood tests to assess your current health status. Following these tests, you will consult with your doctor to review the plan and address any questions. A nurse will then check your vital signs to ensure you are ready for the next steps. Crucially, you’ll receive a thyrotropin alfa (Thyrogen®) injection. This injection is vital as it stimulates any remaining thyroid cells to absorb radioactive iodine more effectively, maximizing the treatment’s reach.
Day 2: Diagnostic Dose and Thyrogen Injection
Day two includes another thyrotropin alfa injection, further preparing your thyroid cells. Two hours post-injection, you will receive a small diagnostic dose of radioactive iodine, either as a pill or liquid. This dose is minimal and does not necessitate any radiation safety precautions.
Day 3: Pre-Therapy Scan and Treatment Dose
On day three, a pre-therapy scan is performed. This scan, often using a gamma camera in a nuclear medicine setting, is essential to see how your body is absorbing the diagnostic dose of radioactive iodine. This is not a “car scan,” but a specialized medical imaging procedure. It helps your doctor determine the most effective therapeutic dose of radioactive iodine for your treatment. It’s important to note that thyroid shielding is not typically used during these types of scans as the goal is to assess iodine uptake in the thyroid and any cancer cells. Therefore, the question of “covering your thyroid” in this context is not applicable and could even interfere with the scan’s accuracy.
Following the scan, you will receive your prescribed treatment dose of radioactive iodine. This is an outpatient procedure, allowing you to return home the same day without an overnight hospital stay.
3 to 5 Days Later: Post-Therapy Scan
A few days after your treatment, you will return for a post-therapy scan. This scan is crucial for your doctor to visualize where the treatment dose of radioactive iodine was absorbed within your body, helping to evaluate the treatment’s effectiveness and plan further care if needed. Again, this scan is a medical procedure within a hospital or clinic, not a “car scan,” and thyroid shielding is not used during this therapeutic assessment.
A thyroid scan helps doctors see how radioactive iodine is absorbed in your body.
Family Planning and Radioactive Iodine Therapy
If you are planning to have children, it is crucial to discuss your plans with your doctor before starting radioactive iodine treatment.
Key considerations include:
- Pregnancy Prevention: Avoid becoming pregnant or fathering a child for at least 6 months after radioactive iodine therapy.
- Contraception: Use effective contraception for at least 6 months post-therapy to prevent pregnancy.
Your doctor may advise a longer period based on your specific situation.
Breastfeeding and Radioactive Iodine Treatment
If you are breastfeeding or pumping breast milk, you must completely stop at least 12 weeks (3 months) before your treatment. This is essential to prevent radioactive iodine from concentrating in breast tissue that contains milk.
Unfortunately, you cannot resume breastfeeding or pumping for your current child after treatment, as your breast milk could expose them to radiation. However, it is generally safe to breastfeed future children. Discuss any concerns about breastfeeding and future family planning with your doctor.
Insurance and Financial Considerations
Once your treatment plan is finalized, contact your insurance company. Inquire about the need for prior authorization for any treatments and tests. Prior authorization is confirmation from your insurer that a particular test, treatment, or procedure is deemed medically necessary. For any questions regarding insurance prior authorization, you can contact MSK’s Patient Billing at 646-227-3378.
Planning Private Transportation Post-Treatment
Before your treatment day, arrange for private transportation to take you home. Due to the radiation emitted after treatment, public transportation is not permitted.
Acceptable private transportation options include:
- Walking
- Driving yourself
- Being driven by someone you know
- Using a private car service. If someone else is driving, ensure they are the only other person in the car.
If traveling with a driver, maximize distance by sitting in the back seat, diagonally opposite the driver, maintaining a distance of at least 3 to 6 feet (1 to 2 meters).
What to Expect on Your Radioactive Iodine Treatment Day
Preparing for the Day
- Showering: You can shower with soap and water the evening before or on the morning of your treatment.
- Personal Care Products: Continue using your regular deodorant, lotions, creams, and makeup.
- Medications: Discuss your thyroid medication with your doctor. They will advise if you should take it on the day of treatment. Take all other regular medications as usual.
- Diet: Stick to your low-iodine diet. Have a light, low-iodine breakfast (like oatmeal) at least 2 hours before your appointment. Do not eat anything within 2 hours of treatment, but you can drink low-iodine liquids like water up to 2 hours before.
- What to Bring: Bring items to help you pass the time, such as books, magazines, a laptop, iPad, or cell phone. You can take these items home with you after treatment without concern for radiation risk.
Arriving for Treatment
Arrive promptly for your appointment. Your nuclear medicine coordinator will provide specific instructions on where to go and how to check in.
The Treatment Process
Your treatment day will include a nuclear medicine scan performed in MITS using a large imaging machine. This scan typically takes around 45 minutes but could be longer. Again, this is a medical scan within a controlled environment, not a “car scan,” and thyroid shielding is not used as it’s designed to measure iodine uptake.
After the scan, you will be taken to a private room in the outpatient treatment area. Family and friends can join you in the room but must leave before the treatment begins.
In your private room:
- Your doctor, nurse, and a health physicist will meet with you to answer any questions about the treatment and explain the radiation safety precautions you’ll need to follow after treatment. You will receive written instructions and sign a consent form.
- A nurse will check in with you and administer medication to prevent nausea or vomiting. Refrain from eating for at least one hour after taking this medication, or as directed by your doctor.
Receiving Your Radioactive Iodine Treatment
Once your visitors have left, your doctor will administer your radioactive iodine treatment in your room. The dosage is precisely calculated based on your blood tests and pre-therapy scan results.
- Pill Form: If receiving pills, you may get one or more, depending on your dose, taken with water.
- Liquid Form: If receiving liquid radioactive iodine, you will drink about 1 teaspoon (5 milliliters) from a small vial through a straw. The liquid is clear and mostly tasteless, often described as tasting like water or slightly stale.
Immediately after treatment, a health physicist will use a handheld device to monitor your radiation level. You will need to remain in your room for at least one hour post-treatment. You can use your phone or watch TV during this time, but visitors are not permitted. While immediate side effects are uncommon, they may develop later.
Post-Radioactive Iodine Treatment Care
Radiation Safety Instructions: Protecting Others
Following your radioactive iodine treatment, your body will emit radiation. Adhering to radiation safety instructions is essential to minimize exposure to those around you. These instructions, provided by your healthcare team, are crucial for the safety of your family and the public.
Minimizing Exposure: Time, Distance, and Precautions
- Time: Limit the duration of close contact with others. Shorter periods of proximity reduce radiation exposure.
- Distance: Maintain physical distance. Increased distance significantly reduces radiation exposure.
- Stay at least 6 feet (2 meters) away from pregnant women and individuals under 18 for the first 24 hours.
- Maintain a minimum of 3 feet (1 meter) distance from all others for 24 hours.
- Avoid sleeping in the same bed with anyone for 2 to 3 days. Sleep at least 6 feet (2 meters) apart.
- Special Precautions: If you share a bed with a baby, child, or pregnant woman, or if you are a primary caregiver for a child under 18, contact the health physics department at 212-639-7391 for personalized safety instructions, available Monday to Friday, 9 AM to 5 PM.
Travel Guidelines
- Security equipment at airports and tunnels can detect minute amounts of radiation. You will receive a wallet card confirming your radioactive medicine treatment, valid for up to 3 months. Present this card to law enforcement if stopped at checkpoints.
- Public transportation is prohibited for 24 hours post-treatment. Use private transportation methods ensuring a distance of 3 to 6 feet (1 to 2 meters) from others. If traveling for more than 4 hours, consult the health physics department before leaving the hospital.
| Transportation Guidelines |
|—|—|
| Permitted | Not Permitted |
| – Walking | – Public transportation (train, bus, subway, plane) for 24 hours post-treatment |
| – Private car | |
| – Personal car (self-driving or pickup) | |
| – Car travel: Limit to 2 occupants, sit diagonally from driver in back seat, or furthest seat from driver in larger cars | |
Returning to Work and Social Activities
Your health physicist will advise on when it is safe to return to work, typically 1 to 2 days post-treatment, potentially longer depending on your occupation and proximity to others.
Resuming Sexual Activity
Your health physicist will provide guidance on when sexual activity can be safely resumed after treatment. Discuss birth control options with your doctor to prevent pregnancy, and avoid conceiving or fathering a child for at least 6 months post-treatment.
Facilitating Radioactive Iodine Clearance
Most of the unabsorbed radioactive iodine is eliminated through urine, with smaller amounts in saliva, sweat, and bowel movements. Follow these guidelines to expedite clearance:
- Hydration: Drink at least 8 (8-ounce) cups of liquid daily, starting immediately after treatment and continuing for 5 to 7 days. Focus on water and water-based drinks. No need to drink during the night, only while awake.
- Frequent Urination: Urinate frequently to empty your bladder, as urine will be radioactive. Try to avoid urine spillage; if it occurs, use gloves and clean with disinfectant. For 2 days post-treatment, men should sit while urinating to minimize splashing, unless otherwise instructed.
- Regular Bowel Movements: Aim for regular bowel movements for about a week to clear radioactive material from your colon. If prone to constipation, discuss laxative use with your doctor beforehand. Contact your doctor if no bowel movement occurs within 24 hours post-treatment.
- Sour Candies for Saliva Production: Sucking on sour hard candies starting 24 hours post-treatment for about 3 days can help alleviate dry mouth by stimulating saliva production, aiding in iodine elimination.
- Contact Your Nurse: For any issues like nausea or stomach pain, contact your nurse.
Post-Treatment Diet and Medications
- Normal Diet: You can resume your regular diet 24 hours after treatment, unless your doctor specifies otherwise.
- Continued Hydration: Maintain high fluid intake for 5 to 7 days post-treatment, aiming for at least 8 cups daily.
- Alcohol Consumption: If you consume alcohol, limit intake to 1 or 2 drinks per day.
- Medications: Restart thyroid medications (if previously stopped) and other regular prescriptions the day after treatment, as per your doctor’s instructions.
- Anti-nausea Medication: You will be provided with anti-nausea medication to take home, use as needed.
Potential Side Effects
You may experience some side effects post-treatment, including:
- Mild Nausea: This is possible immediately after taking radioactive iodine, but pre-treatment medication should help prevent it.
- Cheek Swelling: Swelling in cheeks can occur due to salivary gland irritation, potentially starting the morning after treatment and lasting up to a year. Contact your doctor for painful swelling, bad taste, or odor in saliva.
- Dry Mouth: Dry mouth, especially with higher doses, can occur immediately or up to a year later, potentially becoming permanent in rare cases. Hydration and sour candies can help.
- Taste Changes: Altered taste, often described as salty or metallic, may occur due to taste bud irritation, usually resolving within 8 weeks.
- Neck Discomfort: Neck discomfort may occur in the first 2 to 3 weeks, depending on residual thyroid tissue. Over-the-counter pain relievers like acetaminophen (Tylenol®) can help. In very rare cases, neck swelling causing breathing difficulty can occur, requiring immediate emergency room visit and contacting your MSK doctor.
Seek immediate emergency care if you experience breathing difficulties.
Follow-up Care
A follow-up appointment with MITS is scheduled 3 to 5 days post-treatment for a post-therapy scan to assess iodine absorption.
Before your follow-up:
- Shower thoroughly with soap and warm water.
- Wash your hair well with shampoo.
- Wear clean clothes, avoiding previously worn garments from during or after therapy.
Cleanliness ensures clear scan images. Contact MITS at 212-639-6652 with scan queries.
During follow-up, your doctor may order further scans or blood tests to adjust thyroid medication dosage as needed. Subsequent follow-up appointments are typically scheduled every 6 months. Appointment details are available in MSK’s patient portal, MSK MyChart. For MyChart assistance, contact MITS at 212-639-6652.
Contact Information
For medical issues, contact your endocrinologist during weekday hours. For after-hours, weekend, or holiday concerns, call 212-639-2000 and ask for the on-call endocrinologist.
For appointment or treatment questions, call MITS at 212-639-6652 during weekday hours.
For radiation safety inquiries, contact the health physics department at 212-639-7391 during weekday hours.
Resources
Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
NYC shared ride, door-to-door service for disabled individuals unable to use public transport.
Air Charity Network
www.aircharitynetwork.org
877-621-7177
Travel assistance to treatment centers.
American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Information and services, including Hope Lodge® for patient and caregiver accommodation during treatment.
American Thyroid Association
www.thyroid.org
Up-to-date information for thyroid patients, families, and the public.
Light of Life Foundation
www.lightoflifefoundation.org
(609) 409-0900
Medical information and support for thyroid cancer patients.
National Cancer Institute (NCI)
www.cancer.gov
800-4-CANCER (800-422-6237)
Comprehensive cancer information, treatment guidelines, research news, and clinical trial listings.
Resources for Life After Cancer (RLAC) Program
646-888-8106
MSK program for post-treatment patients and families, offering seminars, support groups, counseling, and assistance with insurance and employment issues.
ThyCa: Thyroid Cancer Survivors’ Association, Inc.
www.thyca.org
877-588-7904
Information and support for thyroid cancer patients at all stages, and resources for caregivers.
