Information on Radioactive Iodine

Because the cancer was in the lymph nodes, I have to take the radioactive iodine treatment. As of right now, if I have a job, I'll be doing the treatment after the wedding and honeymoon. Here's some information I found online about it. I have not talked to a medical specialist about what will happen in my case, or what I will be doing.

From the Mayo Clinic:

Radioactive iodine treatment uses large doses of a form of iodine that's radioactive. Radioactive iodine treatment is often used after thyroidectomy to kill any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.

Radioactive iodine treatment comes as a capsule or liquid that you swallow. The radioactive iodine is taken up primarily by thyroid cells and thyroid cancer cells, so there's a low risk of harming other cells in your body.

Side effects may include:

• Nausea
• Dry mouth
• Dry eyes
• Altered sense of taste or smell
• Pain where thyroid cancer cells have spread, such as the neck or chest

Most of the radioactive iodine leaves your body in your urine in the first few days after treatment. During that time you'll need to take precautions to protect other people from the radiation. For instance, you may be asked to temporarily avoid close contact with other people, especially children and pregnant women.

From Endocrine Web:
Thyroid cells are unique in that they have the cellular mechanism to absorb iodine. The iodine is used by thyroid cells to make thyroid hormone. No other cell in the body can absorb or concentrate iodine. Physicians can take advantage of this fact and give radioactive iodine to patients with thyroid cancer. There are several types of radioactive iodine, with one type being toxic to cells. Papillary cancer cells absorb iodine and therefore they can be targeted for death by giving the toxic isotope (I-131). Once again, not everybody with papillary thyroid cancer needs this therapy, but those with larger tumors, spread to lymph nodes or other areas, tumors which appear aggressive microscopically, and older patients may benefit from this therapy. This is extremely individualized and no recommendations are being made here or elsewhere on this web site...too many variables are involved. But, this is an extremely effective type of "chemotherapy" will little or no potential down-sides (no hair loss, nausea, weight loss, etc.).

Uptake is enhanced by high TSH levels; thus patients should be off of thyroid replacement and on a low iodine diet for at least one to two weeks prior to therapy. It is usually given 6 weeks post surgery (this is variable) can be repeated every 6 months if necessary (within certain dose limits).


There's also some information WebMD, which tells you what to expect:

Radioactive iodine, given in a liquid form, is absorbed and concentrated by the thyroid gland. The treatment destroys thyroid tissue but does not harm other tissue in the body.

See an illustration of the thyroid gland .

While radiation can cause thyroid cancer, treatment of hyperthyroidism with radioactive iodine does not increase your chances of getting thyroid cancer.

What To Expect After Treatment

Within days, the radioactive iodine passes out of your body in your urine.

To avoid exposing other people to radioactivity, it is important to do the following for the first 5 days after your treatment:

• Drink plenty of fluids.
• Avoid spending a lot of time around others, especially children and pregnant women.
• Do not sit next to someone in a motor vehicle for more than 1 hour.
• Avoid kissing or sexual intercourse.
• Sleep in your own room.
• Use separate towels, washcloths, and sheets. Wash these and your personal clothing separately for 1 week.

To further reduce the chance of exposing other people to radioactivity:

• Wash your hands with soap and lots of water each time you use the toilet.
• Keep the toilet very clean. Men should urinate sitting down to avoid splashing. Also, flush the toilet 2 or 3 times after each use.
• Rinse the bathroom sink and tub thoroughly after using them.
• Use separate (or disposable) eating utensils for the first few days and wash them separately.

Why It Is Done

Radioactive iodine may be used to treat hyperthyroidism in people who have noncancerous (benign) thyroid nodules that make too much thyroid hormone.

Radioactive iodine is also used if you have your thyroid removed (thyroidectomy) because of thyroid cancer. Radioactive iodine therapy destroys any remaining thyroid tissue or cancer cells that were not removed during surgery.

How Well It Works

In almost all cases, your thyroid hormone levels will return to normal or below normal after radioactive iodine treatment. This may take 8 to 12 weeks or longer. If your thyroid hormone level does not go down after 6 months, you may need another dose of radioactive iodine.

If you have thyroid cancer and you are treated with radioactive iodine, it may take from several weeks to many months for your body to get rid of any remaining cancer cells.

Your thyroid nodule is unlikely to grow after being treated with radioactive iodine.

Risks

The risks from radioactive iodine treatment include:

• Metallic taste in your mouth.
• Dry mouth.
• Sore throat.
• Neck pain. Radioactive iodine treatment can make your neck swell up or hurt.
• Nausea or vomiting, which is usually mild.
• Constipation or diarrhea.
• Fatigue.
• Unusually low (hypothyroidism) or unusually high (hyperthyroidism) thyroid levels

Pathology Results

Last night I got a call from Dr. Caldwell with the results of the surgery: I can officially say I'm a cancer survivor!

(Source)

The nodule was cancerous, and it spread to 3 of the lymph nodes. I need to do radioactive iodine treatments, and I'm hoping I can get in to my specialist's (Dr. Freedman) office ASAP.

For the most part, it confirms what we've suspected. I thought it was going to come back cancerous, but never dreamed that it had gone to any lymph nodes. I am so thankful to Dr. Chamberlain (my primary doctor) for feeling the thyroid, and even though almost every test came back normal, he continued to pursue it. I am also so glad we decided to do a biopsy, even though it grew only a small amount. If we waited another year to do this, it could be too late, or way more difficult to cure or fight.

This entire experience, even though it's not over, has been so wonderful. No, I would never ask for this to happen, but in the experience, I came out of a mini depression seeing all the friends and family that truly love, support and care for me, I saw that Josh is the right man for me (not that I ever doubted it, it just reassured me that Josh is the one that will take care of me in sickness and in health), and I got my own experience with God. I always believed, but never had a moment where I said, this is what it means to be a Christian, and this is my moment where I know that He IS here, and He is helping me through everything. This has done so much for my faith, and I'm hoping to write a blog or journal, or perhaps just a regular blog centered on it, about my faith. I'm not sure what I want to do yet, or how I will, but I'll let you know (I'll also take suggestions!).

Thank you so much for your prayers and love!

Information on Parathyroid

In addition to being careful of my trachea, voice box, and other things inside my neck, the surgeon is going to have to be careful of my parathyroid.

Most people have four pea-sized glands, called parathyroid glands, on the thyroid gland in the neck. The parathyroid glands make parathyroid hormone (PTH), which helps your body keep the right balance of calcium and phosphorous.

My doctor said that people REALLY only need one, but they need to preserve as many of them as possible during the surgery. If anything happens to them, I'll have calcium problems. My mom works with someone who's mom had calcium issues, and it lead to many other issues inclucing stroke problems.

There's a lot to pay attention to!

Information on Thyroid Nodules

A lot of the information on nodules are repetitive. I went to the Mayo Clinic and the NIH for information on this, and the information is very similar.

The main information:

Thyroid nodules are growths of cells in the thyroid gland. These growths can be noncancerous (benign) or cancerous (malignant). Some nodules are fluid-filled (cysts), while others are made of thyroid gland cells. Sometimes, what feels like one nodule will actually be a collection of small nodules.

Thyroid nodules are more common in women than in men. A person's chance of a thyroid nodule increases with age.Only a few thyroid nodules are cancerous. 

Symptoms

Most thyroid nodules don't cause signs or symptoms. Occasionally, however, some nodules become so large that you can:

• Feel them
• See the swelling at the base of your neck

They may become apparent when you're shaving or putting on makeup. Men sometimes become aware of a nodule when their shirt collars suddenly feel too tight.

In some cases, thyroid nodules produce too much thyroxine, a hormone normally secreted by your thyroid gland. The extra thyroxine can cause problems such as:

• Sudden, unexplained weight loss
• Nervousness
• Rapid or irregular heartbeat

Although thyroid nodules are seldom cancerous (malignant), a nodule is more likely to be cancerous if it:

• Grows quickly or feels hard
• Causes you to become hoarse or to have trouble swallowing or breathing
• Causes enlarged lymph nodes under your jaw or in your neck

Exams and Tests

Very often, nodules produce no symptoms. Doctors will find thyroid nodules only during a routine physical exam or imaging tests that are done for another reason. However, thyroid nodules that are big enough to feel during a physical exam occur in a few people.

If the doctor finds a nodule or you have symptoms of a nodule, the following tests may be done:

• Fine needle aspiration biopsy
• Thyroid scan
• Thyroid ultrasound
• TSH level

Treatments and drugs

Depending on the type of thyroid nodule you have, your treatment options may include:

• Watchful waiting. If a biopsy shows that you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You're also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring. Talk to your doctor if you're not comfortable with this approach or want more information on other options.
• Thyroid hormone suppression therapy. This involves treating a benign nodule with levothyroxine (Levoxyl, Synthroid), a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There's no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary.
• Radioactive iodine. Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months.
  Because thyroid hormone is released into your bloodstream as the nodules are destroyed, in rare cases your symptoms may worsen for a few days or weeks after therapy. You also might experience neck tenderness or a sore throat. And because this treatment eventually causes thyroid activity to slow considerably, you may develop hypothyroidism.
• Surgery. The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue — a procedure called near-total thyroidectomy. Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by a biopsy also need surgical removal so they can be examined more thoroughly for signs of cancer.
  Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone.

You can get full information from the two links at the top of the page.

Information on Thyroid Cancer

There's a ton of information out there! A med student friend of mine sent me the information below. You can also find a ton of good information here.

Thyroid cancer

Definition

Thyroid cancer is a cancerous growth of the thyroid gland.

Alternative Names

Tumor - thyroid; Cancer - thyroid

Causes

Thyroid cancer can occur in all age groups.

People who have had radiation therapy to the neck are at higher risk. Radiation therapy was commonly used in the 1950s to treat enlarged thymus glands, adenoids and tonsils, and skin disorders. People who received radiation therapy as children are at increased risk for getting thyroid cancer.

Other risk factors are a family history of thyroid cancer and chronic goiter.

There are several types of thyroid cancer:

• Anaplastic carcinoma (also called giant and spindle cell cancer) is the most dangerous form of thyroid cancer. It is rare, and does not respond to radioiodine therapy. Anaplastic carcinoma spreads quickly and invades nearby structures such as the windpipe (trachea), causing breathing difficulties.
• Follicular carcinoma accounts for about 30% of all cases and is more likely to come back and spread.
• Medullary carcinoma is a cancer of nonthyroid cells that are normally present in the thyroid gland. This form of the thyroid cancer tends to occur in families. It requires different treatment than other types of thyroid cancer.
• Papillary carcinoma is the most common type, and usually affects women of childbearing age. It spreads slowly and is the least dangerous type of thyroid cancer.

Symptoms

• Cough
• Difficulty swallowing
• Enlargement of the thyroid gland
• Hoarseness or changing voice
• Neck swelling
• Thyroid lump (nodule)

Note: Symptoms may vary depending on the type of thyroid cancer

Exams and Tests

A physical examination can reveal a thyroid mass or nodule (usually in the lower part of the front of the neck), or enlarged lymph nodes in the neck.

Tests for thyroid cancer:

• Elevated serum calcitonin (for medullary cancer) or serum thyroglobulin (for papillary or follicular cancer)
• Laryngoscopy showing paralyzed vocal cords
• Thyroid biopsy showing anaplastic, follicular, medullary, or papillary cancer cells
• Thyroid scan showing a nodule that does not light up on the scan (cold nodule)
• Ultrasound of the thyroid showing a nodule

This disease may also affect the results of the following tests:

• T3
• T4
• TSH

Treatment

Treatment varies depending on the type of tumor.

Surgery is usually the treatment of choice, and the entire thyroid gland is usually removed. If the physician suspects that the cancer has spread to lymph nodes in the neck, these will also be removed during surgery.

Radiation therapy delivered by taking radioactive iodine is often used, with or without surgery. Radiation therapy with an external beam of radiation can also be used.

After treatment, you need to take thyroid hormone to replace what your glands used to make. The dose is usually a little higher than what your body needs, which helps keep the cancer from coming back.

If the cancer does not respond to surgery or radiation and has spread to other parts of the body, chemotherapy may be used, but this is only effective for a third of patients.

Outlook (Prognosis)

Anaplastic carcinoma has the worst outcome of all the types of thyroid cancer. It is usually fatal despite treatment.

Follicular carcinomas are often fast growing and may invade other tissues, but the outlook is still good -- most patients are cured.

The outcome with medullary carcinoma varies. Women under age 40 have a better chance of a good outcome.

Papillary carcinomas are usually slower growing. Most people are cured and have a normal life expectancy.

Many patients who have surgery or radiation for thyroid cancer must take thyroid hormone pills for the rest of their lives.

Possible Complications

• Injury to the voice box or nerve, and hoarseness after surgery
• Low calcium levels from accidental removal of the parathyroid glands during surgery
• Spread of the cancer to the lungs, bones, or other parts of the body

When to Contact a Medical Professional

Call your health care provider if you notice a lump in your neck.

Also call if your symptoms get worse during treatment.

Prevention

There is no known prevention. Awareness of risk (such as previous radiation therapy to the neck) can allow earlier diagnosis and treatment.

References

Ladenson P, Kim M. Thyroid. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 244.

National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology 2008: Thyroid Carcinoma. Version 1.2008.