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They calculate the dosage based on quite a few factors, so there isn’t really a "standard" dose. We heard at October’s conference that the conventional wisdom has changed in the recent past so that doses are now routinely higher than they used to be, as patients receiving higher doses have better outcomes overall (quicker recovery, etc.). 20mci may be higher than some patient’s doses, lower than others ~ keep in mind that thyroid cancer patients routinely receive 10 times that, so it’s still a pretty low dose in the grand scheme of things. If your goal is to remove the thyroid, then you’ve done the right thing by alerting the dosing doctor, and it would appear they are following your lead.
Those restrictions are fairly routine ~ in the first 2-3 days, your body is flushing out the RAI that is not taken up into the thyroid (that’s the remaining 24.1% of the 20 millicuries, after taking into consideration your uptake results), which is done through the body’s fluid waste channels (primarily urine, but also sweat and saliva), and during that time, it’s best just to be completely separate from others. You will likely be encouraged to drink a lot of water and urinate often, that’s meant to dilute the RAI that’s being flushed out and also to flush it out ASAP.
After those first 2-3 days, the restrictions have to do with the radiation emanating from your thyroid ~ obviously it is not something that injures a person (otherwise it’d be bad for US), but radiation exposure is cumulative over a lifetime, and the idea is to limit that cumulative figure for those who have no need of a radiation treatment. The half-life of RAI is 8 days, so every 8 days, the amount that is in your thyroid will reduce by half, until there is such a negligible portion that it’s the same as any other day (we have some radiation in our body naturally). In the meantime, I was told to consider distance and time together ~ if I needed to be very near someone, I should make sure it is for a short period of time, and if I needed to be with someone for a long time, keep them some distance from my throat. With 20 millicuries, you should be down to a negligible point in less than a month (that takes into consideration the 5 that will be flushed out, so if you begin with 20, 15 remain after that happens, then 7.5 would remain after 8 days, 3.75 after 16 days, ~1.9 after 24 days, <1 after 32 days). Restrictions are far more lenient now than when I took my dose (in 1998), FYI.
I had RAI done a week ago and I also had 20 millicures and my uptake was 82 percent…so I guess I absorbed right around 16 millicuries into my thyroid from my understanding. I’ve consulted others who have recently had the same procedure and that dosage didn’t seem alarming to me.
As for instructions afterwards…they seem to vary quite a bit from doctor to doctor and hospital to hospital. I’ve been doing a lot of research and I’ve asked a lot of questions. The Nuclear Medicine Department at my hospital explained there was contamination and then exposure. Contamination was from the first few days when you’re flushing out the ‘extra’ that wasn’t absorbed into your thyroid. They told me that is the biggest thing they want you to avoid exposing people to (bodily fluids such as urine, etc.). They said that could take anywhere from 24 to 72 hours to flush out.
After that it was exposure and that is the radiation your thyroid is actually giving off. I was told it takes 80 days (10 half lives) for them to consider you rid of the entire radiation exposure from the RAI which is why I got a piece of paper stating I had this treatment with a date 80 days away. That way if you travel and happen to set off a radiation detector in an airport you have proof that explains why.
I still have conflicted feelings over some of the advice I’ve been giving about the exposure side of things so I’m still doing research and getting more answers; however, I have a baby to think about so I am definitely being more cautious then I would be if I didn’t.
I am nervous about the time frame to stay away. I have 2 kids, 1 and 3. Mu 1-year-old does not walk yet, so I will have to carry him. 80 days!! O-my! That’s a long time.
I take the iodine pill on a Thursday-my sister will have my kids all day. They will sleep by my mom’s and she will have them all Friday. my husband is home on the weekend, so he will have them Sat and Sun. He will most likely spend the day at his parents. Monday and Wednesday I work until 2:30. Tuesday I work 9-9, so I will not see them. Is it safe to be around them Monday and Wednesday when i get home? I can try to have them play at a distance until my husband is home at 7pm. Maybe my mother-in-law can keep them Monday until 7pm.
It will kill me to not see them so long. My little guy is really attached. When can I safely cuddle? I feel like the radiologists are super relaxed with it. Should I be more concerned than them?
I know it’s hard not to panic about this ~ remember a couple of things.
First, there will be progressively less exposure as the weeks pass ~ no one is saying you must be totally apart for 80 days. The first few days’ separation is for one specific reason, the potential for ingestion of the RAI from your sweat or saliva into their bodies. So it makes absolute perfect sense to just stay all the way apart. After that, the issue is the remaining radiation as it works on your thyroid. It is already reduced from the initial dose, even after the first couple of days. The first week after that, you can make contact brief, but you can still cuddle a few times a day (just not for hours as they sleep in your arms). The next week, you can reduce the restrictions some more (since more of the initial dose will have dissipated), and so on.
In addition, nothing indicates that you are harming your children at that point. These precautions go WAY overboard in terms of what doctors feel may be prudent, they are recommending far more caution than they even believe is necessary, because it’s always better safe than sorry. If you are feeling that way as well, then go ahead and restrict yourself even further than the recommendations would indicate ~ but really, don’t torture yourself over this. I understand about a 1-year-old and having to hold them all the time, so I would suggest that your practice becomes picking them up to move them to a new place, snuggle a moment and then put them right back down in the "new place." Even if it’s just at your feet, that’s a good distance from your neck. It’s just the pocket of your neck that you need to be most concerned with.
I met with a radiologist today and will be moving forward with RAI. My uptae results were 74.9% (normal 12-35%). I expresssed my concern with not wanting a 2nd dose. He said in 15 years, only one person he knows needed a 2nd dose. He said the hospital dose an average of 3 a week. He was very pleasant and helpful. I’m just wondering what average doses are for the I-131? He initially said he would give me 18mci, then he said 20 mci b/c of my worry about needing a 2nd dose.
When I came home, I saw that the endocronologist’s order stated in () radioactive iodine "up to 10mci." Why would they state this? Is 20 mci considered a high dose?
He said to keep away from others for 2 days and then about 6 ft away for another 2 days.
Some perspective: While 20 seems like a reasonably large number, it must be related to the units being measured. So, if you were going for a walk, a 20 inch walk would be much easier, and much, much smaller than a 20 mile walk. When it comes to our dose of RAI the unit is MILLIcuries. One one-thousandth of a curie. It is a wee unit of measurement. And it is being used to give a dose of a radioactive isotope that has a VERY short life span. 8. 1 days in the spectrum of the life spans of radioactive elements is an eye blink compared with other such elements.
As to the 10 half life period: I haven’t done the math. But I saw a chart that had the amount of radioactive element left after 7 half life periods being slightly less than one percent….rounded up, you could say it was 0.8%. So, of that original 20 MILLIcurie dose that will be given, after only seven half lives (49 days for I131), you would have 1.6 ten-thousandths of a curie left .
So where does prudence lie? How much time should we take with our precautions? Rational people can come up with different ideas — and they obviously do, which is what creates so much confusion for us– but the bottom line is we are dealing with VERY SMALL QUANTITIES. Those very small amounts of I131 have not been shown to harm US over the long term. So it stands to reason that the dose is not going to harm someone else, either. Take the advice of the professionals with whom you are dealing. And take a deep breath and try to relax.
So sorry – I should have included a little more about that 80 days. I didn’t want you to be alarmed (as I was) when they hand you a piece of paper with a date months out on it. So…the half-life of this is 8 days meaning…8 days after your procedure the radiation exposure will be HALF and every 8 days thereafter..the same thing. Sorry about not including that in my previous post!!
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