A bottle of multiple doses of radioactive iodine and pills containing one dose. Radioactive iodine is used to treat thyroid cancer and disease. (University of Utah Health)
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SALT LAKE CITY — About 12 years ago, Shirley Crepeaux hesitated when doctors suggested radioactive iodine to treat her thyroid cancer. She trusted her doctors at Huntsman Cancer Institute, but she was still scared and scared.
“When faced with leaving a 12-year-old alone and my husband a widower or drinking some poison, I drink some poison,” she said.
Crepeaux, 54, is a mother of four. She was 12 when she was diagnosed with cancer.
“We try to make a cancer diagnosis a big deal as much as possible,” she said.
However, radioactive iodine therapy is definitely a big deal.
When she was alone in a particular room, she was given a vial to drink and received numerous warnings through a speaker system telling her not to spill it or throw it away. She said it tasted salty.
After drinking, she was told to stay away from pregnant women and children for a week. She was in the bedroom for a week. Crepeaux said it was “very tragic” but her husband did everything he could to help her keep in touch with her family, including video calling the breakfast table and waving through the window.
“Overall, it was a week in my life, and then I got back to myself,” she said.
how does this work
Thyroid cancer is one of the most common cancers and one of the easiest to treat—in part because of radioactive iodine.
Radioactive iodine was first used in the 1930s and 1940s, around the same time chemotherapy was developed and became popular in the 1960s, said Dr. Dev Abraham of Huntsman Cancer Institute. It treats thyroid cancer and disease as well as Graves’ disease, which causes the thyroid to overproduce hormones.
“It has stood the test of time,” Abraham said.
What has changed throughout use is the dose, and Abraham said there have been more recent reports of small but statistically significant increases in radioactive iodine levels, suggesting that too much radioactive iodine can lead to a higher risk of other cancers, leading to dose reductions over the past five to ten years.
The radioactive iodine is administered in capsules or beverages, which Abraham says is a unique targeted therapy. Thyroid tissue, including thyroid cancer tissue that has spread throughout the body, is destroyed by treatment once it enters the cell. Other cells that come into contact with radioactive iodine in the blood are not affected.
“It’s a treatment, depending on the ability of the tissue to absorb, absorb, or trap iodine. Therefore, iodine-trapping tissue is particularly vulnerable to being killed by this low-grade radioactivity,” Abraham said.
Before taking a dose of radioactive iodine, doctors like Abraham help patients starve thyroid and thyroid cancer tissue from iodine by avoiding certain foods, so that these cells starve and absorb more of the radioactive iodine.
Mostly, this treatment is used after surgery to remove most of the cancer to address remaining thyroid tissue that may have cancer cells or spread of cancer cells, which is more common in thyroid cancer than in many other cancers.
In many cancers, spread to other areas leads to a worse prognosis, he said. But with radioactive iodine, the spread of thyroid cancer does not necessarily mean a poorer prognosis.
long term impact
Although the number of deaths is high, not many patients die from thyroid cancer, Abraham said. The American Cancer Society estimates there will be about 43,800 new cases of thyroid cancer and about 2,230 deaths in 2022.
The main goal of radioactive iodine is to reduce the frequency of thyroid cancer recurrences, he said.
Crepeaux, who continues to date Abraham every year, says he has taken care of her for years and it appears she will continue to do well, with the radioactive iodine treatment being effective.
Crepeaux is one of the few thyroid cancer patients with residual disease, a small amount of cancer that does not grow. These could be dying thyroid cancer cells, Abraham said, and in most patients, the cancer cells are still there but not progressing, as good as a cure.
Crepeaux has been dealing with dryness of the nose, throat and eyes due to radioactive iodine therapy. She says she always carries a water bottle with her and uses products to help rehydrate.
That’s one reason why treatment should be tailored to the patient, using the smallest effective dose, Abraham said. Two doses are sometimes used in severe cases, but three are rarely used, he said.
If the cancer does come back and Crepeaux decides to receive a second dose of radioactive iodine, she says it will leave her with no tears, saliva or saliva — and even more discomfort.
Crepeaux worked as a hairdresser for 30 years, but now she’s a medical assistant at school.
“This is what happened to me. It wasn’t me. I was Shirley and I will always be Shirley. A little salty. A little raunchy. …I don’t listen to anyone’s crap. If I love you, I love you I’m not going to let cancer or anything else change or define me,” she said.
She said she was screened for thyroid cancer thanks to her primary doctor. If not, she may die within a few years. When it was discovered, it was between stages three and four and had spread to her lungs. Her only symptoms so far have been shoulder pain and difficulty swallowing.
Now, Crepeaux encourages everyone to self-examine their thyroid for lumps, or have their doctor check them out during their annual physicals.
Crepeaux was told after the surgery that her voice would be very low and hoarse, but therapy and a loud voice helped save her voice – although she said more effort was needed to produce a clear voice now.
“Luckily, I was one of those people who had a very loud voice before the surgery, so now I have a normal voice,” she said.
However, her laughter was still the loud laughter that made everyone else in the room laugh even more.
Overall, Crepeaux shares a message that there is hope and encourages others who have been through similar situations to be grateful and focus on the little things that bring them joy.
“Most people with cancer live with it, they don’t die from it,” she said.