Multiple dose radioactive iodine bottle with a single dose pill. Radioactive iodine is used to treat cancer and diseases of the thyroid gland. (Utah Health University)
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Salt Lake City – Shirley Crepeaux was a bit hesitant when doctors proposed radioactive iodine as a treatment for thyroid cancer about 12 years ago. She trusted her doctors at the Huntsman Cancer Institute, but was still scared and scared.
“When I leave a 12-year-old alone and my husband is a widower or drink poison, I’ll drink some poison,” she said.
Crepeaux, now 54, is a mother of four. When she was diagnosed with cancer, her youngest child was 12 years old.
“We’ve tried to make cancer diagnosis as big as possible,” she said.
However, treatment with radioactive iodine was definitely an event.
She was given a small drinking vial while she was alone in a certain room, and received multiple warnings over the speaker system telling her not to spill or drop it. She said it tastes salty.
After drinking, she was told to stay away from pregnant women and babies for a week. She spent a week in her bedroom. Crepeaux said it was “quite unhappy”, but her husband did what he could to help her stay in touch with her family, including video calls to the breakfast table and waving out the window.
“In the big scheme of things, it was a week in my life and then I went back to being myself,” she said.
How it’s working
Thyroid cancer is one of the most common cancers and one of the easiest to treat – partly because of radioactive iodine.
Dr Dev Abraham of the Huntsman Cancer Institute said radioactive iodine was first used in the 1930s and 1940s, around the same time chemotherapy was being developed, and treatment became popular in the 1960s. It treats cancer and thyroid disease as well as Graves’ disease, which causes an overproduction of thyroid hormones.
“It has stood the test of time,” said Abraham.
What has changed over the course of its use is the dosage, Abraham said there were more recent reports showing a small but statistically significant increase, showing that too much radioactive iodine could cause a higher risk of other cancers, resulting in lower doses in recent years. five to ten years.
Radioactive iodine is given in a capsule or drink, and Abraham said it is a unique targeted therapy. Thyroid tissue, including thyroid cancer tissue that has spread throughout the body, will be destroyed by treatment once it has entered the cell. Other cells that come into contact with the radioactive iodine in the blood will not be affected.
“It is a treatment that is specifically determined by the ability of the tissue to take up, collect, or trap iodine. Thus, iodine-retaining tissues are especially prone to killing by this low-level radioactivity, ”Abraham said.
Before taking a dose of radioactive iodine, doctors like Abraham will help the patient starve the thyroid and thyroid cancer tissue with iodine by avoiding certain foods to keep the cells hungry and absorb more radioactive iodine.
Most often, treatments are given after much of the cancer has been removed by surgery to treat the debris of the thyroid tissue that may contain cancer cells or cancer cells that have spread, which is more common with thyroid cancer than with many other cancers.
He said that in many cancers, spreading to other areas leads to a worse prognosis. But with radioactive iodine, spreading thyroid cancer doesn’t necessarily mean a worse prognosis.
Abraham said that although one death is too many, there are not too many patients who die from thyroid cancer. The American Cancer Society estimates that there were approximately 43,800 new cases of thyroid cancer and approximately 2,230 deaths in 2022.
He said the primary purpose of radioactive iodine is to reduce the rate of recurrence of thyroid cancer.
Crepeaux still meets Abraham every year, said he had looked after her for years and it seems that he will continue to do very well and the treatment with radioactive iodine has been successful.
Crepeaux is one of the few thyroid cancer patients who has residual disease, small amounts of cancer left behind do not grow. Abraham said these are probably dying thyroid cancer cells, and in most patients the cancer cells remaining but not developing are as good as the cure.
Due to radioactive iodine treatment, Crepeaux constantly struggles with dry nose, throat and eyes. She said she always carries a water bottle with her and uses products to help moisturize.
Abraham said this was one reason why treatment should be tailored to the patient, using the lowest effective dose. He said that in severe cases, sometimes two doses are used, but rarely three.
If the cancer came back and Crepeaux decided to take a second dose of radioactive iodine, she said it would lead to a lack of tears, saliva and saliva – even more discomfort.
Crepeaux has been a hairdresser for 30 years but is now in school to become a medical assistant.
“It’s something that happened to me. I am not who I am. I am Shirley and I will always be Shirley. A bit salty. A little dirty. … I’m not having fun with anyone. And if I love you “I love you everyone … I won’t let cancer or anything else change or define me,” she said.
She said it was thanks to her GP that she was screened for thyroid cancer. If she hadn’t, she might have died within a few years. It was between the third and fourth stages when it was found and had already spread through her lungs. Her only symptom up to that point was shoulder pain and difficulty swallowing.
Now, Crepeaux encourages everyone to feel for lumps on the thyroid gland during a self-check or ask their doctor to check you during their annual physical exam.
After surgery, Crepeaux was told she would have a very whispered, hoarse voice, but the therapy and her loud voice helped save her voice – although she said it now takes a lot more effort to make her voice audible.
“Luckily, I was one of those people who had a rough voice before the operation, so now my voice is normal,” she said.
Her laugh, however, is still the same loud laugh, a laugh that causes more laughter from other people in the room.
Overall, Crepeaux shared the message that there is hope and encouraged others going through similar situations to be thankful and to focus on the little things that bring them happiness.
“Most people with cancer live with it, don’t die with it,” she said.