So, needless to say, I couldn't escape this guy:
Mr. DNA, where did you come from?
Genetics were not on my side.
I was definitely in a grey area in terms of whether or not to do the radioactive iodine (RAI) treatment. So after doing my own research online, and taking the advice of my surgeon and endocrinologist into heavier consideration, I decided to proceed with a low dose of iodine.
I may need to back up and explain what this treatment is. Basically, it goes like this. The thyroid gland and thyroid tissue is the only tissue in the body that absorbs iodine, which is found in iodized salt and all seafood, among other things. It uses this iodine to produce the hormone thyroxine, which is used to regulate your metabolism. A surgeon can't possibly get 100% of all thyroid tissue out, as some needs to be left behind when it is attached to important structures/glands in the neck, to avoid damaging them. In addition, there is no way the surgeon can get rid of any individual thyroid cells, whether cancerous or not, because he/she is not a magician.
Therefore, for decades, the standard treatment has been for the patient, once the thyroid gland is removed, to take a pill of iodine that has been laced with radioactivity (I-131). Typically, the patient will do a low-iodine diet (LID) for 2 weeks prior to the dose, so that any thyroid cells that are still alive are starving for iodine. Once the pill comes in, all thyroid cells take in this radioactive iodine, which then works over the next few months to kill that thyroid cell. If the cell is cancerous, then good riddance. If not, then oh well, there was no use for the remnant thyroid tissue anyway.
All the doctors I had spoken to had said that there wasn't necessarily any disadvantage to delaying the RAI to later down the road, but my intuition seemed to think that getting the iodine sooner would prevent any remaining cancer cells (if any) from growing and becoming stronger. In addition, not having the RAI has one slight disadvantage for the years of testing and bloodwork that I was anticipating.
The easiest test to see if thyroid cells still remain is a blood test to test for Thyroglobulin (Tg). If it increases or spikes, it means that thyroid cells are still around, and therefore there is the distinct likelihood that thyroid cancer has returned. If you do RAI, then you expect this number to baseline at zero or near-zero. If you don't, then you have to establish a baseline, and then any differences/spikes in the numbers are open to more interpretation. At least, I think this is an accurate summary based on what the doctors have told me.
Therefore, additional peace of mind comes with doing the RAI, so that any changes in bloodwork in the future can be interpreted more easily. In addition, due to more recent research, there has been a movement toward using smaller doses of RAI, since it has been found they can be as effective while exposing the patient to far less risk/side-effects.
On the flip side, research has shown that having RAI can cause a fraction of a percentage increase in the chance of developing a secondary cancer down the road, specifically salivary gland cancer and leukemia. So, doing RAI isn't without its risks of course. Swallowing radiation rarely comes risk-free. Just ask this guy:
But weighing my options, I decided to proceed with the RAI. I met with Dr. Pawan Gupta at UCLA Nuclear Medicine (real department name), and he spend almost an hour with me walking me through the pros and cons of the RAI. At the end of our meeting, we made the appointment on the calendar. July 31, 2015: the day that I become a superhero.
-W
I may need to back up and explain what this treatment is. Basically, it goes like this. The thyroid gland and thyroid tissue is the only tissue in the body that absorbs iodine, which is found in iodized salt and all seafood, among other things. It uses this iodine to produce the hormone thyroxine, which is used to regulate your metabolism. A surgeon can't possibly get 100% of all thyroid tissue out, as some needs to be left behind when it is attached to important structures/glands in the neck, to avoid damaging them. In addition, there is no way the surgeon can get rid of any individual thyroid cells, whether cancerous or not, because he/she is not a magician.
Therefore, for decades, the standard treatment has been for the patient, once the thyroid gland is removed, to take a pill of iodine that has been laced with radioactivity (I-131). Typically, the patient will do a low-iodine diet (LID) for 2 weeks prior to the dose, so that any thyroid cells that are still alive are starving for iodine. Once the pill comes in, all thyroid cells take in this radioactive iodine, which then works over the next few months to kill that thyroid cell. If the cell is cancerous, then good riddance. If not, then oh well, there was no use for the remnant thyroid tissue anyway.
All the doctors I had spoken to had said that there wasn't necessarily any disadvantage to delaying the RAI to later down the road, but my intuition seemed to think that getting the iodine sooner would prevent any remaining cancer cells (if any) from growing and becoming stronger. In addition, not having the RAI has one slight disadvantage for the years of testing and bloodwork that I was anticipating.
The easiest test to see if thyroid cells still remain is a blood test to test for Thyroglobulin (Tg). If it increases or spikes, it means that thyroid cells are still around, and therefore there is the distinct likelihood that thyroid cancer has returned. If you do RAI, then you expect this number to baseline at zero or near-zero. If you don't, then you have to establish a baseline, and then any differences/spikes in the numbers are open to more interpretation. At least, I think this is an accurate summary based on what the doctors have told me.
Therefore, additional peace of mind comes with doing the RAI, so that any changes in bloodwork in the future can be interpreted more easily. In addition, due to more recent research, there has been a movement toward using smaller doses of RAI, since it has been found they can be as effective while exposing the patient to far less risk/side-effects.
On the flip side, research has shown that having RAI can cause a fraction of a percentage increase in the chance of developing a secondary cancer down the road, specifically salivary gland cancer and leukemia. So, doing RAI isn't without its risks of course. Swallowing radiation rarely comes risk-free. Just ask this guy:
But weighing my options, I decided to proceed with the RAI. I met with Dr. Pawan Gupta at UCLA Nuclear Medicine (real department name), and he spend almost an hour with me walking me through the pros and cons of the RAI. At the end of our meeting, we made the appointment on the calendar. July 31, 2015: the day that I become a superhero.
-W
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