The document discusses treatment options for hyperthyroidism, including doing nothing and monitoring symptoms, surgery, blocking medications, and radioactive iodine treatment. Radioactive iodine treatment involves administering radioactive iodine orally or intravenously, which is absorbed by the thyroid and destroys it, potentially curing the condition but often resulting in hypothyroidism requiring hormone replacement. The process and patient experience of undergoing radioactive iodine treatment at a nuclear medicine facility is described in detail.

1. TREATING HYPERTHYROIDISM CHOICES OF TREATMENT

2. TREATING HYPERTHYROIDISM DO NOTHING SURGERY BLOCKING MEDICATIONS RADIO-ACTIVE IODINE

3. TREATING HYPERTHYROIDISM DO NOTHING ADVANTAGES Might get better “by itself ” DISADVANTAGES COULD TAKE MONTHS TO YEARS SYMPTOMS COULD GET WORSE

4. TREATING HYPERTHYROIDISM SURGERY ADVANTAGES QUICK FIX DISADVANTAGES Surgery risks Require thyroid hormone replacement Risk of hypOcalcemia (low calcium)

5. TREATING HYPERTHYROIDISM BLOCKING MEDICINES (PTU or TAPAZOLE) ADVANTAGES No surgery required No radioactive iodine required DISADVANTAGES Not a cure May be required for years Metallic taste Needs to be taken 3 to 4 times a day Allergy to medication may develop Could cause agranulocytosis (white blood cells disappear)

6. TREATING HYPERTHYROIDISM RADIOACTIVE IODINE ADVANTAGES Can cure the problem Surgery (without surgery) DISADVANTAGES Usually results in hypOthyroidism Activities restricted for a few days after the treatment Sometimes a repeat treatment is required

7. TREATING HYPERTHYROIDISM RADIO-ACTIVE IODINE WHY IS IT USED? HOW LONG HAS IT BEEN USED? IS IT SAFE? WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT

8. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE--- Why is it used? The thyroid normally uses iodine from the blood to make thyroid hormone The thyroid “traps” iodine so it can also “trap” radio-active iodine Radioactive iodine stays in the thyroid and destroys the thyroid and ONLY the thyroid

9. HOW LONG HAS IT BEEN USED? This method of treatment has been used for the past 50 years IS IT SAFE? It is a proven method and it is safe (unless the patient is pregnant) TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE

10. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE -- WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT We will make an appointment for you to go to the nuclear medicine department of your local hospital Once there, you will have the radioactivity of your thyroid measured (we all have a basic amount of radioactivity in our body) Then you will be given a “tracer” amount of radioactive iodine (a pill) by mouth (test dose) Then 2- or 4- hours later the radioactivity in your thyroid will be measured again . It will be measured one more time the NEXT DAY about 24 hours after the “test dose” is given.

11. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE -- WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT You will also have a physician at the nuclear medicine department examine your thyroid and help to determine (along with your physician here), what dose of radio-active iodine to give you to treat your thyroid. This dose is determined with the help of the numbers from your iodine uptake study

12. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE -- WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT Once the calculations are completed and the dose of radioactive iodine is decided upon, it will be ordered for delivery…this delivery is usually the next day, now day #3. Once the capsule has arrived, you will be given the radio active capsule. You will not feel any differently, nor will you need to be protected from the radioactivity (the people who handle this material everyday will be protected because of their repeated exposure)

13. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE -- WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT The physician at the hospital will give you some guidelines which are designed to conform with NY state regulations. These guidelines are REQUIRED by the state to be given to you. Some patients become frightened when they hear the guidelines. You need to remember that this treatment is very safe and that no harm has come to individuals related to treated persons. If there were any reasons to have a concern about this form of treatment, we would not be recommending it.

14. TREATING HYPERTHYROIDISM with RADIOACTIVE IODINE -- WHAT CAN YOU EXPECT WHEN YOU GO TO THE NUCLEAR MEDICINE DEPARTMENT You will also have a thyroid scan (picture) taken after receiving an intravenous injection (this will take place on the first or second day of the study). This scan will tell us which part of your thyroid is functioning (or over-functioning) and which might not be functioning

15. TREATING HYPERTHYROIDISM Five days after your treatment dose with radioactive iodine, you will likely be asked to re-start the anti-thyroid medications that you were taking before the dose (some patients will not need to do this)—make sure you know if you are (or are not) to start your anti-thyroid medication

16. TREATING HYPERTHYROIDISM You should call us after your treatment if you have any questions about how to proceed You should have an appointment with us approximately one month after your treatment dose.

17. SUMMARY Treatment options are as follows: 1) watching and doing nothing actively, but following clinically 2) having surgery 3) the likely use of beta blockers (and their role in preventing symptoms) , regardless of the therapy chosen 4) using PTU (or TAPAZOL) to control the gland initially 5) using Radioactive Iodine to ablate the gland (the patient understanding that lifetime replacement with thyroid hormone would then be required). The patient also understands that #5 could follow #4; or that #4 could follow #5. Finally, the sequence #4-5-4 is also possible.

18. SUMMARY Suggestions are welcomed THE END