Patient Instructions Precautions And Followup

Following the administration of therapeutic doses of RAI, contamination from excretion of RAI in urine, perspiration, breastmilk, and saliva, can be associated with internal accumulation of RAI by others who come in contact with the patient. Potential avenues of radiation exposure to others include ingestion of iodine-131 excreted by the patient, and from emitted gamma rays from iodine-131 (Table 3). Although there is little evidence to suggest that small amounts of radiation from iodine-131 treated patients can cause significant problems to

182 Table 3

Instructions for Patients Receiving Radioactive Iodine Treatment and Follow-Up

Before treatment:

If there is a possibility that you are pregnant, inform the physician. RAI treatment should not be given to pregnant women.

If you are breastfeeding, you must stop for several days before treatment. After treatment, you cannot restart breastfeeding for that child. You may breastfeed with the birth of your next child.

Do not eat for two hours before or after receiving treatment

For the first 72 hours after treatment:

Drink plenty of fluids to help flush any extra radioactive iodine from your body.

Do not spend prolonged periods of time closer than 3 feet to any adult, or within the same room as any child.

For 4-7 days after treatment, including the first 72 hours:

Void as often as possible. Flush toilet twice after use.

Wash hands thoroughly and routinely.

Do not share eating utensils or towels. Use separate or disposable eating utensils.

Wash utensils separately or before placing in dishwasher.

Avoid close contact with children and pregnant women (not closer than 2 feet) for long periods of time. Sleep in a separate bed. If you are caring for a child, brief contact is acceptable, but avoid prolonged close contact, such as sitting in your lap.

Avoid kissing and sexual intercourse.

Occasionally, there may be temporary neck or gland soreness. This can be treated with over-the-counter pain relievers like acetominophen.

Follow-up:

Follow-up with your primary physician in four to six weeks and at regular intervals thereafter. Occasionally, a second treatment may be necessary. You may require long-term thyroid hormone supplementation. Eye problems from Graves' disease may also occur or worsen after treatment.

Do not get pregnant for at least six months, and not until your medical condition has resolved. Consult your physician before getting pregnant.

Abbreviation: RAI, radioactive iodine.

others, guidelines have provided simple recommendations to reduce unnecessary radiation exposure, especially to pregnant women, infants, and children. It is a requirement of the United States Nuclear Regulatory Commission to give patients verbal and written instructions prior to treatment with RAI.

The Society of Nuclear Medicine has recommended that patients sleep alone for the first few days after treatment. For the first 72 hours, patients should not spend prolonged periods of time closer than three feet to any adult, or within the same room as any child. An easy to follow guideline is to maintain a distance of one arm's length between treated persons and others. Short periods of contact are acceptable. If caring for an infant, patients should minimize the amount of time spent in close proximity with the infant during this time.

Specifically, infants should not be held for prolonged periods because of proximity to the thyroid or bladder. It is also recommended that time spent with pregnant women and young children be minimized for four to seven days after treatment. Work restrictions should be given to patients who may potentially expose pregnant women or children when performing their occupation.

Fluid intake and frequent voiding should be encouraged for at least the first 24 hours following treatment. Patients should be instructed to wake up at least once the night following treatment to empty their bladder. The toilet should be flushed two or three times. Handwashing should be performed routinely and frequently. If patients perspire heavily, clothing should be washed separately. Because of contamination concerns, it is not recommended to treat women during their menses. Sharing food and eating utensils should be prohibited. Patients should wash their utensils separately or use disposable utensils.

Lactating women who wish to be treated should be instructed to discontinue breastfeeding. Treatment should be withheld until lactation ceases. It may be possible to detect radioactivity in breast milk for several months following treatment. Patients should be instructed not to resume breastfeeding until the birth of another child.

Women capable of childbearing should be asked to avoid pregnancy for at least six months following treatment, in order to confirm resolution of hyper-thyroidism in addition to minimizing risks from radiation.

Patients should be told that symptoms would resolve over several weeks, and that they would require close follow-up, as hyperthyroidism may worsen during the intervening time. Symptoms of uncontrolled hyperthyroidism should be described, and patients should be informed to seek medical attention if such symptoms occur. They should also be made aware of the probable need for thyroid hormone supplementation in the future. The risk of persistent hyperthyroidism and myxedema following treatment necessitates close follow-up that includes clinical examination and thyroid function tests. Patients with GD should be made aware that ophthalmopathy may occur or worsen. Patients should follow-up with their physician in four to six weeks. One study suggests that the assessment of treatment response may be most reliable at 12 to 14 weeks after therapy, although it may be possible to identify nonoptimal respon-ders as early as six to eight weeks (68). Instructions for patients are summarized in Table 3. In the United States, the most current regulations for RAI therapy may be obtained from the U.S. Nuclear Regulatory Commission.

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