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Radioactive Iodine Therapy for Thyroid Cancer: Inpatient Treatment

This information explains radioactive iodine therapy to treat thyroid cancer in the inpatient setting.
 
Treatment with radioactive iodine helps reduce the risk that thyroid cancer will come back. It is also used to treat thyroid cancer that has spread. Radioactive iodine enters your bloodstream and is taken up by your thyroid cells. The radioactivity destroys the cancer cells.
 

Preparing for Your Treatment

Treatment plan

Your treatment will consist of the following steps:
 
  • You will have blood tests.
  • You will receive a small diagnostic dose of radioactive iodine and you will have scans. You will not have to follow any precautions after you receive the dose.
  • Your treatment will be done in the inpatient setting, meaning that you will be admitted to the hospital. You will probably be in the hospital for 1 night.
    • The radioactive iodine is usually given in pill form, although it can be given in liquid form. Some people have trouble swallowing pills. If you do, tell your doctor in Nuclear Medicine before your treatment.
  • You will have scans after your treatment. These scans will allow your doctor see where the radioactive iodine was taken up in your body.

Contact your insurance company

Once your doctor has given you your treatment plan, call your insurance company to find out if you need preauthorization for any treatments and tests. Your doctor’s office and the hospital will not know this information. If you need help with preauthorization, contact Patient Financial Services at (212) 639-8242.
 

The Day Before Your Treatment

A clerk from the Admitting Office will call you after 2:00 pm the day before your treatment. He or she will tell you when to arrive for your treatment. If you do not receive a call by 7:00 pm, please call (212) 639-7881.
 

The Day of Your Treatment

On the morning of your treatment, follow the guidelines below.
 

Hygiene

  • You can shower with soap and water the night before or the morning of your treatment.
  • You can apply your usual deodorant, lotions, creams, and makeup.

Medications

  • Take your thyroid medication if your doctor tells you to take it.
  • Take all of your other usual medications.

Diet

  • Continue to follow a low-iodine diet.
  • Eat a light breakfast, such as cereal or toast.
  • Your treatment will probably be in the afternoon, so bring a light lunch or snack. Your first delivered meal will be dinner, which will be served in your room after your treatment is finished.

What to bring

You will be staying in a private room. It will have a telephone, TV and DVD player, and a bathroom. You can bring the following items with you:
 
  • Comfortable clothes to wear during the day
  • Sleep wear
  • Toiletries, such as soap, a toothbrush, deodorant, shampoo, and conditioner
  • Sanitary pads (if you expect to be menstruating at that time)
  • Sour hard candy to help with the dry mouth some patients experience after treatment. Your doctor will tell you when to start sucking on them.
  • Books, magazines, laptop computer, DVDs, cell phone, and other items to help pass the time. You can take these items home with you after your treatment. Any small amounts of radiation on these items will not harm you or anyone else

Where to go

Go to the main hospital at 1275 York Avenue between East 67th and East 68th Streets. The Admitting Office will be on the ground floor, on the right hand side. Please arrive on time.
 

Getting ready for your treatment

  • You will be taken to a private hospital room as soon as it is available. Regardless of how long you have to wait, you will be treated that day and your discharge will not be delayed. Your friends and family can stay in your room before treatment, but must leave after you have been given your treatment.
  • You do not have to be in bed during the day and you can wear your own clothing, preferably something loose and comfortable.
  • You will be given a low-iodine diet menu to order your meals. All of your food will be delivered on a disposable tray with disposable utensils.
  • You will not need to have an intravenous (IV) line or blood tests.
  • Before you are given your treatment, your nurse will evaluate you. You will be given medication to prevent nausea or vomiting. Do not eat for 2 hours after you have taken this medication.
  • Your doctor and radiation safety officer will come to your room to answer your questions and discuss the precautions you must follow after your treatment. You will be given a written copy of these instructions. You will then be asked to sign a consent form.

During Your Treatment

You will be given the dose of radioactive iodine. The dose will be based on the results of your blood tests and scans. A team of doctors will decide how much you will receive. You will be given water to swallow the dose.
 
  • The pill form of radioactive iodine comes in capsules about the size of a vitamin. The dose is usually given with 2 to 4 pills.
  • The liquid form of radioactive iodine is about ¼ cup (4 fluid ounces). You will drink it out of a small vial through a straw. The liquid is clear and has little to no flavor. Most patients say it tastes like water, though some say that it has a slightly stale or musty taste.

After Your Treatment

After you receive your treatment, you must stay in your room at all times. The door to your room can stay open. Your visitors must stay outside your room, but they can talk to you from the doorway.
 
You will need to start sucking on sour hard candies after your treatment. Your doctor will tell you when to start doing this.
 
The hospital staff that will be taking care of you has been trained in radiation safety. They may enter your room to attend to your needs. However, they will have to limit the time they spend with you. They will speak with you from the doorway if they do not need to enter your room. Please tell your nurse if you need help or have any problems such as nausea or an upset stomach.
 
To limit the amount of radiation that gets on things in your room, protective covers will be placed on your phone, bedside table, and wash basin. A disposable mat will be put by the toilet. You will have a container to throw away your trash. A radiation safety staff member will remove all trash daily.
 
The morning after your treatment, the radiation level in your body will be measured. Once the level is low enough, you will be discharged. Most patients can leave the morning after treatment. If it is likely that you will need to stay in the hospital more than 1 night, you will be told before your treatment. Sometimes, radiation stays in the body longer than expected. In that case, you will need to stay in the hospital until the level is safe.
 
You may not experience any side effects of the radioactive iodine right after you receive it, but you may have side effects later. These are described in the “Side Effects” section below. 
 
Some of the radioactive iodine will be taken up by your thyroid cells, but the remainder will exit your body quickly. Most of the remaining iodine will exit your body in your urine, but smaller amounts will also exit your body in your saliva, sweat, and stool.
 
To help the iodine exit your body quickly:
 
  • Drink plenty of liquids. Try to drink at least 1 cup of liquid every hour while you are awake. Do this for 2 to 3 days after your treatment. You can drink water, juice, soda, tea, etc. You do not have to wake up at night to drink liquids.
  • Urinate often. Since your urine will be radioactive, you must take extra care to contain it. Women can urinate as usual. Men must sit when urinating.
  • Move your bowels regularly to reduce the dose of radiation to your intestines. If you are often constipated, ask your doctor about taking laxatives before your treatment. If you do not have a bowel movement within 24 hours after your treatment, call your doctor.
  • Call your nurse if you have any problems, such as nausea or an upset stomach.

Discharge Instructions

Diet

  • You can resume your usual diet the day after your treatment.
  • Continue to drink plenty of liquids for 2 to 3 days after your treatment.
  • If you drink alcohol, do so in moderation.

Medication

  • If you were told to stop taking your thyroid medications, start taking them again the day after your treatment.
  • Take all other prescribed medications as instructed by your doctor.

Travel

  • Do not travel by plane, train, subway, or bus for the first 24 hours after you are discharged. This is to make sure you are not in close contact with other people for long periods of time. Even a short subway ride could become long if the train gets stuck or delayed.
  • You will receive a card to show to authorities, if needed. The card states that you received treatment in Nuclear Medicine and that you may give off small amounts of radioactivity for up to 1 month after your treatment. Use it if you are stopped by law enforcement at a checkpoint, such as the airport or outside a tunnel.

Using your cell phone 

You can use your cell phone without any restrictions.
 

Returning to work

Your radiation safety officer will tell you when you can go back to work.
 

Sexual activity

  • Your doctor or radiation safety officer will tell you when it’s safe to resume sexual activity.
  • Ask your doctor or nurse about using birth control.
  • If you plan to get pregnant or father a child, speak with your doctor about this before your treatment.
  • Ask your doctor if or when it is safe for you to breastfeed.

Side Effects

You may experience the following side effects after your treatment:
 
  • Mild nausea right after you take the radioactive iodine. You will receive antinausea medication before your treatment to prevent this.
  • Swelling in your cheeks from irritation or damage to your salivary glands. This can occur as early as the morning after your treatment and continue as long as a year after your treatment. Call your doctor if you have:
    • Painful, swollen glands
    • Foul-tasting saliva
    • Bad-smelling saliva
  • Dry mouth, which is caused by irritation or damage to your salivary glands. This is rare with smaller doses of radioactive iodine. Dry mouth can occur right after treatment or it can occur for several months to a year after treatment. Drink plenty of liquids, as instructed. Sucking on sour hard candy after your treatment can help.
  • Changes in taste caused by irritation of your taste buds. You may notice that food tastes salty or metallic after your treatment. This is temporary and usually goes away within 8 weeks after your treatment. Try foods with different flavors to ensure you are getting the nutrition you need.
  • Neck pain that feels like a nagging soreness. This can occur during the first 2 to 3 weeks after your treatment, but it depends on the amount of thyroid tissue still in your neck. A mild pain reliever such as acetaminophen (Tylenol®) should help.
In very rare cases, the treatment can cause enough swelling to make it hard to breathe. This is a serious condition. If you have trouble breathing, go to your nearest hospital emergency room immediately. Have them call your immediately doctor at Memorial Sloan Kettering Cancer Center (MSK).
 

Follow-up Care After Your Treatment

About 1 week after your treatment, you will return to Nuclear Medicine. You will have a scan to see where the radioactive iodine was taken up in your body. You will get an appointment card before you go home. Call (212) 639-6652 if you have any questions about the scan.
 
Your doctor also:
 
  • May order other scans based on your healthcare needs
  • May order blood tests to see if the dose of your thyroid medication needs to be changed
  • Will tell you when to call to make your 6-month follow-up appointment
At MSK, care doesn’t end after active treatment. The Resources for Life After Cancer (RLAC) Program is for patients and their families who have finished treatment. This program has many services, including support groups, seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues. For more information, call (646) 888-4740 or go to:  www.mskcc.org/cancer-care/survivorship/services-survivors#resources-for-life-after-cancer-program
 

Resources

American Cancer Society
1-800-ACS-2345
 
American Thyroid Association
 
National Cancer Institute (NCI)
1-800-4-CANCER
 
Light of Life Foundation
(646) 888-4740
 
ThyCa: Thyroid Cancer Survivors’ Association, Inc.
1-877-588-7904