High dose radioiodine outpatient treatment: an initial experience in Thailand

Document Type : Short communication


1 Office of Atoms for Peace; Chulabhorn Hospital, Bangkok, Thailand

2 Rajavithi Hospital, Bangkok, Thailand

3 Office of Atoms for Peace, Bangkok, Thailand

4 Rajavithi Hospital; College of Medicine, Rangsit University, Bangkok, Thailand


Objective(s): The aim of this study was to determine whether high-dose radioactive iodine (Na131I) outpatient treatment of patients with thyroid carcinoma is a pragmatically safe approach, particularly for the safety of caregivers.
Methods: A total of 79 patients completed the radiation-safety questionnaires prior to receiving high-dose radioactive iodine treatment. The questionnaire studied the subjects’ willingness to be treated as outpatients, along with the radiation safety status of their caregivers and family members. In patients, who were selected to be treated as outpatients, both internal and external radiation exposures of their primary caregivers were measured, using thyroid uptake system and electronic dosimeter, respectively.
Results: Overall, 62 out of 79 patients were willing to be treated as outpatients; however, only 44 cases were eligible for the treatment. The primary reason was that the patients did not use exclusive, separated bathrooms. The caregivers of 10 subjects, treated as outpatients, received an average radiation dose of 138.1 microsievert (mSv), which was almost entirely from external exposure; the internal radiation exposures were mostly at negligible values. Therefore, radiation exposure to caregivers was significantly below the public exposure limit (1 mSv) and the recommended limit for caregivers (5 mSv).
Conclusion: A safe 131I outpatient treatment in patients with thyroid carcinoma could be achieved by selective screening and providing instructions for patients and their caregivers.


Main Subjects

1. United States. Dept. of Energy. Office of Scientific and Technical Information. Regulatory analysis on criteria for the release of patients administered radioactive material. Final report. Oak Ridge, Tenn.: United States. Dept. of Energy. Office of Scientific and Technical Information; distributed by the Office of Scientific and Technical Information, U.S. Dept. of Energy; 1997. Available from: www.osti.gov/scitech/servlets/purl/453778.
2. Grigsby PW, Siegel BA, Baker S, Eichling JO. Radiation exposure from outpatient radioactive iodine (131I) therapy for thyroid carcinoma. JAMA. 2000;283(17):2272-4.
3. Protection. ICoR. Release of patients after therapy with unsealed radionuclides. Ann ICRP. 2004;34(2):v-vi, 1-79.
4. International Commission on Radiological Protection., International Atomic Energy Agency.Release of patients after radionuclide therapy. Vienna, Austria: International Atomic Energy Agency; 2009.
5. Pacilio M, Bianciardi L, Panichelli V, Argiro G, Cipriani C. Management of 131I therapy for thyroid cancer: cumulative dose from in-patients, discharge planning and personnel requirements. Nucl Med Commun. 2005; 26(7):623-31.
6. Remy H, Coulot J, Borget I, Ricard M, Guilabert N, Lavielle F, et al. Thyroid cancer patients treated with 131I: radiation dose to relatives after discharge from the hospital. Thyroid. 2012; 22(1):59-63.
7. International Atomic Energy Agency. Nuclear medicine in thyroid cancer management : a practical approach. Vienna: International Atomic Energy Agency; 2009.
8. Azizmohammadi Z, Tabei F, Shafiei B, Babaei AA, Jukandan SM, Naghshine R, et al. A study of the time of hospital discharge of differentiated thyroid cancer patients after receiving iodine-131 for thyroid remnant ablation treatment. Hell J Nucl Med. 2013; 16(2):103-6.
9. Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. 2011; 21(4):335-46.
10. Hennessey JV, Parker JA, Kennedy R, Garber JR. Comments regarding Practice Recommendations of the American Thyroid Association for radiation safety in the treatment of thyroid disease with radioiodine. Thyroid. 2012; 22(3):336-7.
11. Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma. A populationbased study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991. Cancer. 1997; 79(3):564-73.
12. Marriott CJ, Webber CE, Gulenchyn KY. Radiation exposure for ‘caregivers’ during high-dose outpatient radioiodine therapy. Radiat Prot Dosimetry. 2007; 123(1):62-7.
13. Barrington SF, Kettle AG, O’Doherty MJ, Wells CP, Somer EJ, Coakley AJ. Radiation dose rates from patients receiving iodine-131 therapy for carcinoma of the thyroid. Eur J Nucl Med. 1996; 23(2):123-30.
14. de Carvalho JW, Sapienza M, Ono C, Watanabe T, Guimaraes MI, Gutterres R, et al. Could the treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of (131I)NaI, on an outpatient basis, be safe? Nucl Med Commun. 2009; 30(7):533-41.
15. Venencia CD, Germanier AG, Bustos SR, Giovannini AA, Wyse EP. Hospital discharge of patients with thyroid carcinoma treated with 131I. J Nucl Med. 2002; 43(1):61-5.
16. Leslie WD, Havelock J, Palser R, Abrams DN. Largebody radiation doses following radioiodine therapy. Nucl Med Commun. 2002; 23(11):1091-7.
17. Culver CM, Dworkin HJ. Radiation safety considerations for post-iodine-131 thyroid cancer therapy. J Nucl Med. 1992; 33(7):1402-5.
18. Siegel JA, Kroll S, Regan D, Kaminski MS, Wahl RL. A practical methodology for patient release after tositumomab and (131)I-tositumomab therapy. J Nucl Med. 2002; 43(3):354-63.