The treatment that is performed after a total thyroidectomy, when thyroid cancer was spread to other tissue or lymph nodes, is a dose of radioactive iodine. The radioactive iodine is absorbed by remaining thyroid tissue, destroying the tissue.
When you have had a total thyroidectomy, thyroid replacement hormone medication, levothyroxine, (L-T4) will be prescribed. This small pill has to be taken for the rest of life. The body also needs T3 and it coverts it from the T4.
To prepare the body for the radioactive iodine treatment it has to go into a state of hypothyroidism. Becoming "hypo" may cause side effects such as tiredness, difficulty sleeping, depression, constipation, weight gain and anxiety attacks.
What is involved in becoming "hypo"? The process takes 4-6 weeks. The thyroid replacement hormone, levothyroxine, is stopped. Cytomel (L-T3), a fast acting and fast dissipating form of the thyroid hormone, may be prescribed to minimize the symptoms of hypothyroidism.
Why become "hypo"? When stopping the hormone replacement medication the body will become stimulated to produce the hormones by itself. This will cause the thyroid stimulating hormone to become elevated. For a successful radioactive iodine (RAI) treatment the thyroid stimulating hormone (TSH) level needs to be at least 30 mlU/L. The thyroid stimulating hormone causes any remaining thyroid tissue to produce thyroglobulin (Tg), absorb the radioactive iodine and destroy remaining thyroid tissue.
Along with going off thyroid stimulating hormone medication, a low iodine diet is to be followed for two weeks prior to the radioactive iodine treatment. Reducing the iodine intake through dietary sources will maximize the absorption of the RAI. Information about a low iodine diet can be obtained from your doctor or from a thyroid cancer society.
What I have just described to you in the previous paragraphs has been the usual and most common way of preparing for a RAI treatment. But now in the last few years there is another way of elevating the TSH level of a patient. This is done by giving the patient two doses of Thyrogen簧. This medication is a form of thyroid stimulating hormone. A few of the possible side effects may be headache, nausea, vomiting and weakness. The pharmacist will provide a complete list of side effects that may occur The drug is injected in a muscle, usually the buttocks, by a health practitioner at a hospital, clinic or office, With this procedure there is no need for the body to go into a state of hypothyroidism. Although the patient will still have to follow a low iodine diet for two weeks prior to the RAI treatment but will not have to contend with the side effects of being "hypo" for 4-6 weeks. Because there is no need to stop the daily thyroid hormone supplements, there will be no major down time before or after the radioactive iodine treatment.
Although this procedure sounds like the only way to go to prepare for a RAI treatment, there are a couple drawbacks. One is availability. There are shortages because of inventory constraints. Another reason for the shortages is because of the increased demand because of the ease of preparing for treatment. Most time doctors will ask low risk patients to wait out the shortage. The second drawback can be the cost of the drug. The average cost of the Thyrogen簧 treatment is approximately sixteen hundred dollars. There are some health insurances that will cover the cost and some that do not. It is always a good idea if this is the procedure the doctor wants to do, to check with your insurance carrier first.
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