[pavelsergaziev]

#1060629

Greetings. My mom has Graves and she wants to do radiotherapy. We live in Europe, she is considering going to Warsaw, Poland for treatment. Their approach is to give a small dosage of radioactive iodine that doesn’t kill the gland completely, but renders it inactive for a decade or so, after which time it is supposed to regulate itself and revert to normal hormone levels.

Thing is we haven’t had any kind of radioiodine treatment for hyperthyroidism in our country until recently, so there’s no information on long-term effects on our respective forums. So I’m asking the question here. What happens in 10, or 15, or 20 years after the treatment? Is there a higher chance of developing cancer? Or any other health issues? This thing is radioactive, after all…

Does anyone here have experience with this? I mean, maybe a doctor, or someone who has had RAI long time ago?

We’d be very grateful if you could answer.

[Kimberly]

#1183731

Hello and thanks for being a great advocate for your mom! We are fellow patients, not doctors, but here are a few thoughts that will hopefully be helpful…

For patients who were treated in the United States several years ago, doctors used to try to give just the right dose of RAI that would kill off *part* of the thyroid but not all of it. The theory was that if you destroyed just the right amount of thyroid tissue, that the patient would end up euthyroid (normal) and wouldn’t have to take *any* meds. However, many of these patients ended up experiencing a recurrence of hyperthyroidism. If you have to give a second dose of RAI, the dose tends to be much higher to ensure that the remaining thyroid tissue absorbs enough to make the treatment effective. So the procedure in the U.S. is now to give patients a “fully ablative” dose on the first RAI treatment, meaning a high enough dose to completely destroy all thyroid function.

I don’t know your mom’s age, but if a future pregnancy is a consideration, there is a recommended 6-12 month waiting period after RAI…and antibodies can potentially remain elevated beyond the 12-month mark, which requires extra vigilance, as antibodies can be passed on to a fetus.

I also don’t know if your mom has existing eye issues, such as bulging, swelling, or double vision. The latest guidance from the American Thyroid Association and American Association of Clinical Endocrinologists does NOT recommend RAI for patients with moderate to severe eye involvement, as the eye issues could become worse. For mild eye involvement, some doctors will recommend a course of steroid therapy in conjunction with the RAI to reduce the risk of eye issues. However, it’s important to be aware that steroid therapy can come with significant side effects.

In terms of cancer risk, there are only a small number of studies that are specific to RAI for hyperthyroidism vs. thyroid cancer. (RAI for thyroid cancer involves a significantly larger dose.) One larger study involved 35,000 patients who were followed for 20+ years. This study indicated *no* increased risk of death from cancer. I know of two smaller studies noted a slightly increased risk of specific types of cancer following RAI.

Also, make sure your mom is aware of any hospitalization/isolation procedures following RAI. In the U.S., patients are sent home the same day, but I believe that in Europe, patients are actually hospitalized for several days.

We have many members here who chose RAI as their treatment option, so hopefully, they will jump in here. All three treatment options (RAI, anti-thyroid medications, thyroid surgery), have risks and benefits, so the important thing is to do your research before making a final decision.

Wishing you and your family all the best!

[pavelsergaziev]

#1183727

Thank you very much for your reply, Kimberly.

My mom’s in her fifties, so pregnancy is not a consideration. Also, she has no Gaves-related eye issues.

I’ve seen an advice to check for anything that could possibly spawn malignant tumors after the treatment, since radiation usually leads to rapid growth of everything. Not sure if that advice is medically sound, and also not sure how to do this check-up…

[pavelsergaziev]

#1183728

Thank you very much for your reply, Kimberly.

My mom’s in her fifties, so pregnancy is not a consideration. Also, she has no Gaves-related eye issues.

I’ve seen an advice to check for anything that could possibly spawn malignant tumors after the treatment, since radiation usually leads to rapid growth of everything. Not sure if that advice is medically sound, and also not sure how to do this check-up…

[Kimberly]

#1183729

pavelsergaziev wrote:

I’ve seen an advice to check for anything that could possibly spawn malignant tumors after the treatment, since radiation usually leads to rapid growth of everything. Not sure if that advice is medically sound, and also not sure how to do this check-up…

Hello – I would check the source to see if it is from a trusted and well-recognized medical association. If so, there should be more information available. You and your mom can also initiate this discussion with her doctor. A good doc *should* be willing to discuss both risks and benefits of any treatment option.

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