Saturday, 28 January 2012

Graves' Disease and Radioactive Iodine Treatment

To learn more about Graves' Disease visit :
MedLine PLus

Is Radioiodine (I -131) Therapy (RAI) safe??

For years thyroid patients have been told that RAI is completely safe, presents very little risk of further health problems, and is the insurance policy against heart problems for Graves’ patients and cancer recurrence for thyroid cancer patients. We have been told that only the thyroid takes up iodine, so the RAI will not possibly affect any other part of the body. But is this true? Do the experiences of patients bear this out in reality?

Some of the very real side effects of RAI experienced by patients:

1. The skin on the body peels off in a similar fashion as mild sunburn. This may include the mucosal linings.
2. No sense of taste for at least a month. Others have reported 3 months, and some never regain the sense of taste again.
3. Very swollen and painful salivary glands for a month. Some patients experience this years after RAI, and some have the loss of salivary gland function for life.
4. Digestive problems including food not being properly digested, constipation, or extreme diarrhea for long periods of time.
5. Sudden onset of allergies or food sensitivities including the inability to eat gluten.
6. Iodine deficiency due to low-iodine diet prior to RAI.
7. Adrenal fatigue
8. Compromised immune system
9. Burning tongue

Graves’ patients have an added problem of becoming newly hypothyroid. The process of testing thyroid levels, adjusting thyroid hormone dosage and dealing with hypothyroid symptoms begins for many after RAI ablation. Patients have reported sudden weight gain, digestive changes, skin changes, and other common hypothyroid symptoms after undergoing RAI for hyperactive thyroid disease. It is quite a change for these patients, and must be considered as a long-term result of RAI.

Another long-term affect of RAI in Graves’ patients also includes Graves’ eye disease which actually worsens for many people after radiation treatment.

Doctors are wrong when they tell patients that iodine is only used by the thyroid. In fact, iodine is used by the thyroid, breasts, brain, heart, gastrointestinal system, skin, ovaries, lungs, eyes, mouth, bones, blood, and is used in the production of hormones and is accumulated by the immune system.

What are the alternatives to RAI?

Hyperthyroidism/Graves’ Disease: The National Graves Disease Foundation lists anti-thyroid drugs and sub-total thyroidectomy as standard alternatives to RAI (which is also listed as a standard treatment). For patients who want to avoid anti-thyroid drugs, RAI, or surgery, alternative treatments using magnesium and iodine could be successful according to Dr. Guy Abraham.  Other treatments used by patients with hyperthyroidism include using L-Carnitine, Magnesium and Calcium to help reduce thyroid activity.

It is important that thyroid patients have the WHOLE STORY about RAI, aka I-131. There are real and unpleasant side effects that most doctors don’t reveal to their patients. I have heard many stories from cancer survivors and Graves’ patients who felt pushed and confused, and had no idea what treatment to choose. For many patients, iodine deficiency is a possible cause for cancer and autoimmune disease. Addressing deficiencies and detoxifying the body can be an option for patients who do not chose RAI. For those who are candidates for RAI, please look at the alternatives as well. Once you swallow that pill there is no turning back. As a 3-time RAI patient recently said, “You can never expect to be 100% after taking a toxic substance meant to kill off part of your body.”

Additional Resources:

Iodine and Thyroid Health:

Alternative Treatments for Hyperthyroidism:







Is there any special preparation needed for the procedure?

You should not eat or drink after midnight on the day of the procedure. If you have been taking anti-thyroid medications, you must stop at least three days before the therapy is given.

You will be able to return home following radioactive iodine treatment, but you should avoid prolonged, close contact with other people for several days, particularly pregnant women and small children. The majority of the radioactive iodine that has not been absorbed leaves the body during the first two days following the treatment, primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces.

If your work or daily activities involve prolonged contact with small children or pregnant women, you will want to wait several days after your treatment to resume these activities. Patients with infants at home should arrange for care to be provided by another person for the first several days after treatment. Your radiologist can be more specific for your given situation, but usually this time period is only two to four days.

Your treatment team will give you a list of other precautions to take following your treatment with I-131. The following guidelines comply with the Nuclear Regulatory Commission:
  • Use private toilet facilities, if possible, and flush twice after each use.
  • Bathe daily and wash hands frequently.
  • Drink a normal amount of fluids.
  • Use disposable eating utensils or wash your utensils separately from others.
  • Sleep alone and avoid prolonged intimate contact for three or four days. Brief periods of close contact, such as handshaking and hugging, are permitted.
  • Launder your linens, towels, and clothes daily at home, separately. No special cleaning of the washing machine is required between loads.
  • Do not prepare food for others that requires prolonged handling with bare hands.
  • If you are breast-feeding, you must stop.
  • You should avoid becoming pregnant from six months to one year after treatment.
  • You must be sure you are not pregnant before receiving I-131. Many facilities require a pregnancy test within 24 hours prior to giving I-131 in all women of child-bearing age who have not had a surgical procedure to prevent pregnancy.
Patients who need to travel immediately after radioactive iodine treatment are advised to carry a letter of explanation from their physician. Radiation detection devices used at airports and federal buildings may be sensitive to the radiation levels present in patients up to three months following treatment with I-131. Depending on the amount of radioactivity administered during your treatment, your endocrinologist or radiation safety officer may recommend continued precautions for up to several weeks after treatment.

Radioiodine therapy is not used in a patient who is pregnant. Depending on the stage of pregnancy, I-131 given to the mother may damage the baby's thyroid gland. In such a case, discussion of the issue with the patient's physician is advised. When given to a nursing mother, radioactive iodine can reach a baby through her breast milk. Most physicians feel that this procedure should not be used in women who are breastfeeding unless they are willing to cease breastfeeding their newborn. Also, it is recommended that pregnancy be delayed until at least six to 12 months after I-131 treatment.

Women who have not yet reached menopause should fully discuss the use of I-131 with their physician.

New York Thyroid Center

Thyroid Cancer Treatment for Graves' Disease

Columbia University Medical Center, Department of Surgery, New York, NY.

When used to treat Graves' disease, radioactive iodine therapy cures hyperthyroidism by destroying the hyperactive thyroid cells. A single dose (between 3 and 12 mCi) of radioactive iodine is given as a pill in order to treat hyperthyroidism. RAI is about 90% effective in curing the condition. For the additional 10%, a second dose of radioactive iodine is needed. Only a few percent of people fail this second dose and require surgery to remove the overactive thyroid gland.

Radioactive iodine takes several months in order to have its full effect, although symptoms should definitely improve after about four weeks. Additional anti-thyroid medications and beta blockers may be necessary to control the hyperthyroidism during this initial time period. However, because it is impossible to give just enough radioactive iodine to destroy the exact right amount of thyroid gland without causing hypothyroidism, the eventual result is usually an underactive thyroid. However, this hypothyroidism may not occur for years because there may be a small amount of hyperfunctioning thyroid tissue after treatment. Eventually this overactive remnant will burn out and you will be left with a deficiency of thyroid hormone.

Short-term side effects may include nausea and vomiting soon after treatment, which usually only lasts for a day or two. In addition, some of the RAI may be picked up by the salivary glands around the jaws and under the tongue, causing painful swelling and enlargement of these glands. This is treated by drinking plenty of fluids, sucking on lemon drops (in order to stimulate the flow of saliva) and occasionally pain medicine like aspirin or acetaminophen.

Because it may take a few weeks after the treatment dose of radioactive iodine before there is a decrease in the blood level of thyroid hormone, you are at risk for a worsening of hyperthyroidism during this period. In many people, this increased period of hyperthyroidism may not be a problem, however, for patients with heart disease or the elderly patient, this period of hyperthyroidism may put them at increased risk for a heart attack because the excess thyroid hormone may overstimulate the heart. For this reason, many practitioners prescribe antithyroid drugs for their patients who are about to undergo radioactive iodine treatment in order to prevent this "thyroid storm".

After undergoing radioiodine treatment for Graves' disease, you will need to follow certain guidelines and precautions in order to avoid potential radiation exposure to close family members and friends. These precautions should be followed for one week if you receive between 3 and 6 mCi of radioiodine, 2 weeks for 6-12 mCi and for one month if more than 12 mCi were administered. (see section on precautions and preparation for RAI scanning and treatment)

A vast amount of valuable information about Thyroid Diseases and Treatment is available from the above website at New York Thyroid Center

Radioactive Iodine

The principle advantage of Radioactive Iodine treatment for hyperthyroidism is that it tends to have a much higher success rate than medications. Depending on the dose of radioactive iodine chosen, and the disease under treatment (Grave's vs toxic goitre, vs hot nodule etc), success rate in achieving definitive resolution of the hyperthyroidism may vary from 75-100%. A major expected side effect of radioactive iodine in patients with Graves disease is the development of life long hypothyroidism requiring daily treatment with thyroid hormone. Occasionally, some patients may require more than one radioactive treatment, depending on the type of disease present, the size of the thyroid, and the initial dose administered. Many patients are initially unhappy at the thought of having to take a thyroid hormone pill for the rest of their lives. Nevertheless, as thyroid hormone is safe, inexpensive, and easy to take, and is identical to the thyroid hormone normally made by our own thyroid, this therapy is generally extremely safe and very well tolerated by the vast majority of patients.

As radioactive iodine treatment results in destruction of thyroid tissue, there is often a transient period of several days to weeks when the symptoms of hyperthyroidism may actually worsen following radioactive iodine therapy. This generally happens as a result of thyroid hormone being released into the blood following the radioactive iodine-mediated destruction of thyroid cells which contain thyroid hormone. In some patients, treatment with medications such as beta blockers (propranolol, atenolol, etc) may be useful during this period of time. Many patients are able to tolerate the initial few weeks without any problem whatsoever.

Most patients do not experience any difficulty after the radioactive iodine treatment, usually given as a small pill. Occasionally, neck tenderness or a sore throat may become apparent after a few days, if moderate inflammation in the thyroid develops and produces discomfort in the neck or throat area. This is usually transient, and not associated with a fever etc.

Women who are breast feeding should discontinue breastfeeding for at least a week, and likely longer, following radioactive iodine treatment, as small amounts of radioactive iodine may be found in breast milk even several weeks after the radioactive iodine treatment.

What are the factors associated with a positive outcome after radioactive iodine? The amount of radioactive iodine administered, severity of existing hyperthyroidism, size of the thyroid, and gender are all factors that influence success of treatment, and provide guidance for the suggested dose of radioactive iodine to be administered. In general, the higher the dose prescribed, the more successful the treatment, as defined by resolution of the hyperthyroidism. See Radioiodine treatment of hyperthyroidism-prognostic factors for outcome. J Clin Endocrinol Metab. 2001 Aug;86(8):3611-7.

Is pretreatment with antithyroid medications necessary prior to treatment with radioactive iodine? This depends on the individual patient and severity of hyperthyroidism. Patients with mild to moderate hyperthyroidism who tolerate the condition well may not require pretreatment with antithyroid medications such as PTU or methimazole. In fact, there is some evidence that pre-treatment of patients with either Graves' disease or toxic goiter with antithyroid drugs reduces the effectiveness of the subsequent radioactive iodine treatment, as described in Propylthiouracil before 131I therapy of hyperthyroid diseases: effect on cure rate evaluated by a randomized clinical trial. J Clin Endocrinol Metab. 2004 Sep;89(9):4439-44 and Propylthiouracil reduces the effectiveness of radioiodine treatment in hyperthyroid patients with Graves' disease. Thyroid. 2004 Jul;14(7):525-30.

In contrast, patients presenting with severe hyperthyroidism may require institution of medications immediately, particularly if problems such as heart disease are being adversely affected by the hyperthyroidism. Randomized clinical studies show that pre-treatment of patients with antithyroid drugs prior to radioactive iodine results in more severe transient rebound hyperthyroidism, compared to patients who received radioactive iodine without pretreatment. For an overview, see J Clin Endocrinol Metab 1999 Nov;84(11):4012-6 Effect of methimazole pretreatment on serum thyroid hormone levels after radioactive treatment in Graves' hyperthyroidism and The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131)I ablation for graves' disease. J Clin Endocrinol Metab. 2001 Jul;86(7):3016-21.

Frequently Asked Questions

Is radioactive iodine expensive? 
The answer to this question depends on the site that orders and administers the radioactive iodine, and may vary widely. At the Toronto General Hospital, the cost for outpatient radioactive iodine for the treatment of hyperthyroidism may range from $250 to $400 CAD, which is not that different from a years supply of medications (PTU or methimazole) used to treat hyperthyroidism.

Is radioactive iodine safe? How do we know?
Several studies have examined the long term follow-up of patients treated with radioactive iodine for hyperthyroidism. Although some studies show a very small increase in mortality for the first few years after treatment, the long term safety seems excellent, with no excess cancer mortality after decades of follow-up. See Long-term comparative cancer mortality after use of radio-iodine in the treatment of hyperthyroidism, a fully reported multicenter study. J Insur Med. 2001;33(2):138-42.  There does not appear to be any significant excess total cancer mortality in patients after radioactive iodine. For example, see the studies published in JAMA 1998 280:347-355 or in Lancet 1999 353:2111-2115.

However, contrasting data on the rate of cancer incidence have been reported in some studies Increased cancer incidence after radioiodine treatment for hyperthyroidism Cancer. 2007 May 15;109(10):1972-9

I am going to take a vacation in the United States immediately after I finish my treatment. Any special precautions needed?
The United States has recently instituted radioactive monitoring devices at some public buildings and transportation venues, which may be activated by patients recently treated with radioactive iodine. Patients planning on traveling to the US within a month of treatment should take a medical letter from their physician attesting to their diagnosis and treatment. See Radiation monitoring and public safety.

For a summary of the possible side effects of radioactive iodine and a discussion of its safety, see Health effects of therapeutic use of 131I in hyperthyroidism. Q J Nucl Med.2000 Dec;44(4):333-9

I received my radioactive iodine last week. When will I feel normal?
The answer depends on many patient-specific variables. For example, patients with extremely large thyroid glands and severe hyperthyroidism may take much longer to achieve resolution of the hyperthyroidism than patients with small thyroid glands and modest hyperthyroidism. Similarly, the larger the dose of radioactive iodine, the more likely that the thyroid gland will be effectively treated. As radioactive iodine can induce considerable inflammation in the thyroid, this leads to leakage of thyroid hormone from the damaged thyroid into the blood. Accordingly, patients symptoms may actually worsen for a few weeks, before they start to improve. In most cases, improvement may be noted by 4-8 weeks after administration of the radioactive iodine, but in more severe cases, it can take longer. Depending on the type of hyperthyroidism present, and other mitigating factors, the time to "feeling normal" can vary considerably, from 1-12 months. These individual issues and expectations should be discussed with your physician.

I am being treated with radioactive iodine for a hot nodule, how effective is this? 
The majority of patients experience a significant reduction in size of the nodule and a decrease in levels of circulating thyroid hormones usually to normal, often within 3-6 months of treatment. In most centers, the development of hypothyroidism in an otherwise normal thyroid gland is rare, and is seen perhaps 10% of the time. See Long-term effect of radioactive iodine on thyroid function and size in patients with solitary autonomously functioning toxic thyroid nodules. Clin Endocrinol (Oxf). 1999 Feb;50(2):197-202.

I would like to receive just the right amount of radioactive iodine to eliminate my hyperthyroidism, but I don't want to become hypothyroid. Can this be done?
This desired outcome is one of the most difficult to achieve in clinical practice. There have been many formulas developed to calculate precisely how much radioactive iodine is required to achieve a perfect outcome, including variables such as the thyroid size, thyroid volume, and radioactive iodine uptake in predictive treatment nomograms. Some studies have reported very appealing results, balancing effective therapy with a reduced risk of hypothyroidism. Striving for Euthyroidism in Radioiodine Therapy of Graves' Disease: A 12-Year Prospective, Randomized, Open-Label Blinded End Point Study. Thyroid. 2011 May 12. [Epub ahead of print]. Unfortunately, despite using various parameters as guidance, it remains very difficult to achieve this outcome. In general, the more one tries not to use too much radioactive iodine, the higher the degree of relapse and requirement for a second treatment. Hence, many physicians will state clearly at the outset that hypothyroidism requiring life long thyroid hormone replacement must be an anticipated outcome in this treatment scenario, so as not to mislead patients that a perfect outcome (thyroid normal, no need to take thyroid replacement tablets) will be achieved. Indeed, studies comparing the outcome after fixed dose versus precisely calculated adjusted dose radioactive iodine administration have failed to show any advantage of more complicated radioactive iodine dosing regimens, as shown in A randomized comparison of radioiodine doses in graves' hyperthyroidism. J Clin Endocrinol Metab. 2003 Mar;88(3):978-83.

I received my radioactive iodine and now my TSH is elevated. Will I be on thyroid hormone for the rest of my life?
Some patients will develop transient hypothyroidism after radioactive iodine, whereas in others, usually the majority of patients who receive effective doses, it may be permanent. The group of patients with transient hypothyroidism seem to develop new thyroid antibodies that block thyroid function temporarily. The usual suggestion is for appropriate monitoring, ~ every 4-10 weeks, until thyroid function stabilizes. See Characterization of thyroid-stimulating blocking antibodies that appeared during transient hypothyroidism after radioactive iodine therapy. Thyroid. 2000 Oct;10(10):909-17.

I want to avoid gaining too much weight after the treatment. Is there anything I can do?
Careful regular blood test monitoring after radioactive iodine administration, usually every 4-8 weeks initially, seems prudent to avoid the development of transient hypothyroidism. If there has been significant weight loss in the course of the hyperthyroid illness, it is reasonable to expect some degree of weight gain, with body weight approaching "prehyperthyroid values" in most patients. Institution of thyroid hormone replacement early in the course of treatment with careful attention to optimal hormone replacement may help minimize the potential for excess weight gain. See Is excessive weight gain after ablative treatment of hyperthyroidism due to inadequate thyroid hormone therapy? Thyroid. 2000 Dec;10(12):1107-11.

What will happen to my thyroid gland and neck after the radioactive iodine?
Some patients will experience mild neck discomfort or sore throat for a few days to weeks after radioactive iodine administration. Less commonly more severe neck discomfort may develop that can last for a few weeks. The use of a non-steroidal anti-inflammatory agent can be helpful in these circumstances. The radioactive iodine will induce an inflammatory process in the thyroid that will result in gradual destruction of thyroid tissue and reduction in the size of the gland. The rate of this process depends on the degree of pre-existing thyroid disease, the size of the thyroid gland, and the dose of radioactive iodine administered.

Should children receive radioactive iodine?
The answer to this question is somewhat controversial, however many centers have successfully used radioactive iodine in the pediatric population with good results. See Pediatric Graves' disease: therapeutic options and experience with radioiodine at the University of Mississippi Medical Center. South Med J. 1997 Oct;90(10):1017-22 and The use of radioactive iodine in the management of hyperthyroidism in children. Curr Drug Targets Immune Endocr Metabol Disord. 2001 Nov;1(3):255-64. and A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves' patients. J Clin Endocrinol Metab. 2004 Sep;89(9):4229-33. and An optimal treatment for pediatric graves' disease is radioiodine. J Clin Endocrinol Metab. 2007 Mar;92(3):797-800.

Do individuals who live near nuclear reactors have to take iodine?
Iodine supplements may be administered to patients at risk for exposure to radioactive iodine release from a nuclear reactor accident, as occurred at Chernobyl. See  Potassium iodide for thyroid blockade in a reactor accident: administrative policies that govern its use. Thyroid. 1997 Apr;7(2):193-7.

Should I be treated with antithyroid drugs for several months first, prior to receiving radioactive iodine for Graves' disease?
The answer depends on how you are feeling and the severity of your hyperthyroidism. For example, if you are extremely ill, or have underlying heart disease with abnormal cardiac rhythms and/or symptoms of heart disease such as shortness of breath and chest pain, then pretreatment with antithyroid drugs first may be advisable. If you have mild to moderate hyperthyroidism which you are tolerating well, you may not need pretreatment with antithyroid drugs. In fact, patients pretreated for several months with PTU or methimazole prior to radioactive iodine will often experience a more severe rebound, albeit transient worsening of their hyperthyroidism after radioactive iodine. Discuss your clinical condition and this issue with your physician if you remain uncertain. More recent data suggests that a 48 hr period of discontinuation of antithyroid drugs prior to radioactive iodine may produce less severe rebound hyperthyroidism, and seems to give reasonable treatment results that are comparable to outcomes achieved after withdrawal of thyroid hormone for 1 week. See Two-day Thionamide Withdrawal prior to Radioiodine Uptake Sufficiently Increases Uptake and does not Exacerbate Hyperthyroidism Compared to 7-day Withdrawal in Graves' Disease. Endocr J. 2006 Aug 8; [Epub ahead of print]and The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131)i ablation for graves' disease. J Clin Endocrinol Metab. 2001 Jul;86(7):3016-21.

I am scheduled for an outpatient radioactive iodine treatment. What is the risk of radiation exposure to my family?
At the dosing limits allowed for prescribing outpatient use of radioactive iodine, there appears to be little risk to family members in the home environment. Patients are encouraged to minimize immediate close contact for a few days, especially of body fluids such as saliva and other excretions. For example, avoid intimate kissing, sharing of food, and hugging and kissing of young children for a few days after the radioactive iodine treatment. A scientific study of this issue is reported in Radiation exposure from outpatient radioactive iodine (131I) therapy for thyroid carcinoma. JAMA. 2000 May 3; 283 (17) :2272-4. Similarly, theoretical analysis of radiation exposure to family members and co-workers shows minimum risk of radiation exposure, however minimizing direct contact for several days after treatment seems prudent. See Potential third-party radiation exposure from outpatients treated with 131I for hyperthyroidism. Med Phys. 2004 Dec;31(12):3194-200.

I am receiving a form of cancer treatment that involves administration of a form of radioactive iodine conjugated to a monoclonal antibody. Will this harm my thyroid?
Although measures are taken to try and protect the thyroid in these situations, hypothyroidism appears to be a common side effect, at least in some early trials. See High-dose myeloablative radioimmunotherapy of mantle cell non-hodgkin lymphoma with the iodine-131--labeled chimeric anti-CD20 antibody C2B8 and autologous stem cell support. Cancer. 2002 Feb 15;94(S4):1363-1372

I am on medication for my hyperthyroidism and I am going to be treated with radioactive iodine-how long do I have to stop my medication before the radioactive iodine treatment?
Although classic advice would suggest stopping the medications (PTU or methimazole) for 5-7 days, some studies suggest discontinuation of medication for only 2 days may still yield satisfactory outcomes-see Two-day Thionamide Withdrawal prior to Radioiodine Uptake Sufficiently Increases Uptake and does not Exacerbate Hyperthyroidism Compared to 7-day Withdrawal in Graves' Disease. Endocr J. 2006 Aug 8; [Epub ahead of print]

Can I take lithium to enhance the effectiveness of radioactive iodine therapy?
Lithium may increase the retention of iodine within the thyroid gland, thereby increasing the efficacy of radioactive iodine. Although lithium is not widely used together with radioactive iodine, emerging data from some studies suggests combining lithium with radioactive iodine might be an effective therapeutic combination Impact of Lithium on Efficacy of Radioactive Iodine Therapy for Graves' Disease: A Cohort Study on Cure Rate, Time to Cure, and Frequency of Increased Serum Thyroxine After Antithyroid Drug Withdrawal. J Clin Endocrinol Metab. 2009 Nov 11. [Epub ahead of print]

Copyright © 2005
The original article can be found HERE

Radioactive Iodine Side Effects In People With Graves’ Disease

By DrEricO23

Radioactive iodine causes a number of different side effects in people with Graves’ Disease, as well as other types of hyperthyroidism. While some people do need this treatment, most people with a hyperthyroid condition do not need radioactive iodine. I personally was diagnosed with Graves’ Disease, and not only did I restore my health back to normal without receiving this harsh treatment method, but I also avoided taking Methimazole, beta blockers, or any other prescription drugs.

Before I discuss some of the other options you have besides receiving radioactive iodine, I want to discuss two huge risks of this treatment method:

Risk #1: Radioactive iodine treatment can make you hypothyroid for the rest of your life. This is the primary side effect of radioactive iodine, as many people end up taking thyroid hormone for the rest of their lives after receiving this harsh treatment method. The reason is because this treatment damages the thyroid gland, which of course will affect the ability of this gland to produce thyroid hormone. So while radioactive iodine can effectively eliminate your hyperthyroid symptoms, it will most likely leave you with hypothyroid symptoms.

And while these symptoms can usually be controlled by taking thyroid hormone daily, why receive a treatment that can damage your thyroid gland, especially when most people with hyperthyroidism have other options to choose from? Since the thyroid gland affects every tissue and cell in your body, you at least owe it to yourself to get a second opinion and look into other treatment options before you receive radioactive iodine.

Risk #2: Radioactive iodine treatment does nothing to address the actual cause of your condition. What I’m about to say might surprise you, as in most cases the malfunctioning thyroid gland is not the actual cause of your condition, even though it is the main reason behind the symptoms of Graves’ Disease or any other hyperthyroid disorder. What this means is that receiving radioactive iodine won’t do anything to address the autoimmune component of Graves’ Disease. This compromised immune system is most likely what led to the malfunctioning thyroid gland in the first place.

So those who just receive radioactive iodine and then take thyroid hormone daily without addressing the actual cause of the disease have a good chance of developing other conditions in the future. In a person with Graves’ Disease, this can lead to another autoimmune thyroid disorder such as Hashimoto’s Thyroiditis, or even other autoimmune conditions, such as Rheumatoid Arthritis, lupus, etc..

But besides the immune system being affected, often times other systems of the body are either directly causing or contributing to the malfunctioning thyroid gland. For example, many people with Graves Disease have stressed out adrenal glands, which in turn can lead to a weakened immune system, eventually causing the thyroid gland to malfunction. So once again, radioactive iodine might help prevent the thyroid gland from secreting thyroid hormone, but it won’t address other bodily components.

Why Don’t Endocrinologists Address The Actual Cause Of The Disorder?

You might wonder why endocrinologists and other types of medical doctors don’t address the underyling cause of these conditions, and instead just manage the symptoms by directly treating the thyroid gland. In fact, most endocrinologists label Graves’ Disease as being incurable. I’m not trying to convince you that there is a cure for Graves’ Disease. All I’m trying to say is that most medical doctors, regardless of their specialty, do not try to get to the underlying cause of the condition. Most of them simply try to manage symptoms, and it’s no different with Graves’ Disease.

When I was initially diagnosed with Graves’ Disease, I considered myself as having a thyroid disorder. But after consulting with a holistic doctor and doing some research of my own, I began to realize that in most cases, the thyroid gland is not the primary cause of the condition. I’m not suggesting that it’s a bad idea to manage the symptoms of the thyroid gland, as in many cases it is important to do this. But if this is all you do, and take extreme measures to do this through the use of radioactive iodine, then you are not doing anything for the actual cause of the disorder, which can lead to the development of other serious problems in the future.

What Options Do You Have Besides Radioactive Iodine Treatment?

If your endocrinologist recommends that you receive radioactive iodine treatment, here are some of the other options you can consider:

Option #1: You can take anti-thyroid drugs. This is not a bad short-term option for managing the symptoms, as prescription drugs such as Methimazole and/or Propranolol can often times do a good job of temporarily controlling your hyperthyroid symptoms. However, you need to keep in mind that these drugs are also not doing anything for the actual cause of the disorder. This is why many people who begin taking these drugs eventually receive radioactive iodine.

Option #2: You can begin a natural treatment protocol. More and more people are choosing natural treatment methods for their autoimmune thyroid condition. Even so, most people with Graves’ Disease are unaware that a natural treatment protocol can potentially restore their health back to normal. The truth is that not everybody is an ideal candidate for a natural treatment protocol. On the other hand, many people can be helped through such a protocol.

One of the most important factors is choosing a competent natural endocrine doctor to consult with. Some people make the mistake of trying to self-treat their condition naturally. While it might be tempting to visit your local health food store and purchase some nutritional supplements and/or herbal remedies, doing so can be dangerous, and in most cases, does not lead to optimal results. The reason for this is because restoring one’s health doesn’t just involve taking a few supplements or herbs, but frequently requires a change in lifestyle as well.

Don’t get me wrong, as nutritional supplements and herbs can be an important part of a natural treatment protocol. But in addition to taking the right supplements/herbs, you also need to make sure they are of high quality, and take the proper dosage. And since everyone has different needs, most will need to take different types and dosages. As a result, it is best to play it safe and consult with an expert.

Option #3: You can choose not to receive any type of treatment. Not choosing any type of treatment isn’t a wise option, as Graves’ Disease is a serious condition. Whether you decide to take anti-thyroid drugs, receive radioactive iodine, or choose natural treatment methods is of course completely up to you. But you really do need to get this condition treated.

In summary, radioactive iodine is a harsh treatment method that has long lasting consequences. And while some people do need to receive it, due to the extreme side effects it really should be a last resort in most cases. At the very least you should get a second opinion before receiving such a treatment, and consider consulting with a natural endocrine doctor to see if you are a candidate for natural treatment methods. By consulting with multiple doctors you can get the information you need in order to make an informed decision, and be completely comfortable with the treatment method you choose.

For more information on how to treat Hyperthyroidism and Graves’ Disease through natural treatment methods, please visit my facebook fan page, Graves Disease and Hyperthyroidism: Natural Treatment Solutions (and don't forget to Like the page while you're there!).

Here are some other articles you might want to check out:

3 Reasons Why You Should Avoid Thyroid Surgery

Thyroid Eye Disease & Natural Treatment Methods

How Graves' Disease Sufferers Can Avoid Radioactive Iodine Treatment

Radioactive Iodine & Graves' Disease VIDEO

RAI (I-131)- Radioactive Iodine. 10 reasons to avoid RAI treatment

Radioactive iodine (I-131) is given orally (either by pill or liquid) on a one-time basis to abate a hyperactive gland. I-131 is given after routine iodine scans, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and it is considered that there are no widespread side effects with this therapy.

10 Reasons to avoid Radioactive Iodine Treatment (RAI):
1.       It is dangerous for breastfeeding and pregnancy. RAI can cause difficulty with future attempts to become pregnant and carry pregnancies to term. RAI is known to affect the ovaries, which is why patients are recommended to avoid becoming pregnancy for at least 6 months after RAI. The 6 months recommendation was increased to at least one year in early 2002. It is not recommended to conceive 8- 12 months after the iodine uptake.
2.      It is permanent; it destroys your thyroid gland and there is no way back.
3.     Hypothyroidism. Radiation-induced hypothyroidism is more difficult to treat than naturally occurring hypothyroidism. Hypothyroidism caused by treatment for hyperthyroidism is known to cause depression and anxiety. In one large Dutch study, "over one third of patients with a full-time job were unable to resume the same work after treatment”.
It appears that many of these patients are in need of psychological support.
4.     Thyroid Eye Disease can become worse. Chance of thyroid eye disease developing increases dramatically, as RAI doesn’t stop antibody production.
5.      You may have to take pills for hypothyroidism for the rest of your life.
6.      RAI, aka spent nuclear fuel ("nuclear waste", in other words) is absorbed by other organs and can cause cell death or DNA mutations. RAI is absorbed, in smaller amounts, by other organs besides the thyroid, including breast tissue, the genitals, pancreas, and the gastric mucosa.
7.    Studies show an increase in cancers, especially of the thyroid gland and small bowel, after RAI
8.    Chance of significant, unhealthy weight gain is increased. Studies show that weight gain is inevitable after radio iodine-induced hypothyroidism
9.      Increased risk of developing fibromyalgia like symptoms
10.  Salivary and tear duct damage from I-131

 So, before taking the decision to solve your Hyperthyroidism/ Graves' Disease problems with the Radioactive iodine pill, consider the above mentioned dangers.

Other Alternative Methods for Hyperthyroidism

9 Reasons to Avoid Thyroidectomy

50 Hyperthyroidism Symptoms

5 Alternative Treatments of Hyperthyroidism


20 Possible Triggers for Hyperthyroidism/ Graves' Disease

Graves' Disease Diet

Graves' Disease Book


About the author: Svetla Bankova is an author of "Life Manual for Graves' Disease and Hyperthyroidism"- a book, based not only  on her experience as a former Graves' Disease patient but also her research as a psychologist. This is  only book that explains step by step how and why Graves' Disease came to your life, the cause and specific steps for alternative treatment of Graves' disease. The book provides also specific steps how to treat Thyroid Eye Disease, numerous practical exercises, recipes for herbal compresses, how to use flax seed oil and many other supplements that will improve your eyes tremendously.

International Journal of Pediatric Endocrinology
Volume 2010 (2010), Article ID 858359, 3 pages
Case Report I-131 Treatment of Graves' Disease in an Unsuspected First Trimester Pregnancy; the Potential for Adverse Effects on the Fetus and a Review of the Current Guidelines for Pregnancy Screening
Phuong Tran, Shane DeSimone, Mark Barrett, and Bert Bachrach

Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor leading to hyperthyroidism. Therapeutic options for the treatment of Graves' disease include medication, radioactive iodine ablation, and surgery. Radioactive iodine is absolutely contraindicated in pregnancy as exposure to I-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism. Here we describe a case of a female patient with recurrent Graves' disease, who inadvertently received I-131 therapy when she was estimated to be eight days pregnant. This was despite the obtaining of a negative history of pregnancy and a negative urine pregnancy test less than 24 hours prior to ablation. At birth, the infant was found to have neonatal Graves' disease. The neonatal Graves' disease resolved spontaneously. It was suspected that the fetal thyroid did not trap any I-131 as it does not concentrate iodine until 10 weeks of gestation.

To read the full Case Report, please click on the link above.

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