Abstract
Thyroid ablation is a procedure where the thyroid tissue is destroyed via radioactive iodine (RAI), percutaneous ethanol injection, radiofrequency, or laser ablation. The most common form of thyroid ablation used in the United States is RAI, in the form of 131I. Thyroid ablation is done in certain patients after the diagnosis of thyroid-stimulating hormone–induced hyperthyroidism (i.e., Graves’ disease), toxic adenomas, or multinodular goiters. It is also used as adjunctive therapy in some intermediate- and high-risk patients with thyroid cancer post surgical removal of the cancer, to kill remnant cancer cells. RAI cannot be performed during pregnancy or breastfeeding, as this would lead to exposure and subsequent destruction of fetal/infant thyroid tissue, and pregnancy should be deferred for 6 to 12 months postablation. RAI is also contraindicated in patients with moderate to severe orbitopathy associated with Graves’ disease, as the orbital antigen is released with RAI treatment, and this could worsen the eye disease. RAI is administered orally as 131I, a colorless, tasteless liquid available as an oral solution or in a carrier capsule, that is well absorbed with a half-life of 8 days and a radiation time of 56 days (99% expended). After a few weeks, because of exposure to beta and gamma radiation from RAI, the follicles that take up RAI and surrounding follicles develop cellular necrosis and start to break down, and hypothyroidism occurs months to years following. Several other drugs can be used adjunctive to RAI to either reduce the symptoms of hyperthyroidism (i.e., thionamides, beta blockers) or possibly improve the efficacy of the therapy (i.e., saturated solution potassium iodide, lithium).
Published Version
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