Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131I: Practice Recommendations of the American Thyroid Association

Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131I: Practice Recommendations of the American Thyroid Association

The American Thyroid Association Taskforce on Radioiodine Safety

James C. Sisson,1 John Freitas,2 Iain Ross McDougall,3 Lawrence T. Dauer,4 James R. Hurley,5 James D. Brierley,6 Charlotte H. Edinboro,7,* David Rosenthal,8, Michael J. Thomas,9, Jason A. Wexler,10,* Ernest Asamoah,11,Anca M. Avram,1,* Mira Milas,12 and Carol Greenlee13

Background: Radiation safety is an essential component in the treatment of patients with thyroid diseases by 131I. The American Thyroid Association created a task force to develop recommendations that would inform medical professionals about attainment of radiation safety for patients, family members, and the public. The task force was constituted so as to obtain advice, experience, and methods from relevant medical specialties and disciplines.

Methods: Reviews of Nuclear Regulatory Commission regulations and International Commission on Radiological Protection recommendations formed the basic structure of recommendations. Members of the task force contributed both ideas and methods that are used at their respective institutions to aid groups responsible for treatments and that instruct patients and caregivers in the attainment of radiation safety. There are insufficient data on long-term outcomes to create evidence-based guidelines.

Results: The information was used to compile delineations of radiation safety. Factors and situations that govern implementation of safety practices are cited and discussed. Examples of the development of tables to ascertain the number of hours or days (24-hour cycles) of radiation precaution appropriate for individual patients treated with 131I for hyperthyroidism and thyroid cancer have been provided. Reminders in the form of a checklist are presented to assist in assessing patients while taking into account individual circumstances that would bear on radiation safety. Information is presented to supplement the treating physician's advice to patients and caregivers on precautions to be adopted within and outside the home.

Conclusion: Recommendations, complying with Nuclear Regulatory Commission regulations and consistent with guidelines promulgated by the National Council on Radiation Protection and Measurement (NCRP-155), can help physicians and patients maintain radiation safety after treatment with 131I of patients with thyroid diseases. Both treating physicians and patients must be informed if radiation safety, an integral part of therapy with 131I, is to be attained. Based on current regulations and understanding of radiation exposures, recommendations have been made to guide physicians and patients in safe practices after treatment with radioactive iodine.

1Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan. 2Department of Radiology, St. Joseph Mercy Hospital, Ypsilanti, Michigan. 3Departments of Radiology (Nuclear Medicine) and Medicine (Endocrinology), Stanford University Medical Center, Palo Alto, California. 4Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York. 5Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York. 6Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada 7Exponent, Inc. Health Group, Menlo Park, California. 8Division of Endocrinology, Nassau University Medical Center, East Meadow, New York. 9Carolina Endocrine, P.A., Raleigh, North Carolina. 10Washington Hospital Center, Washington, District of Columbia. 11Diabetes and Endocrinology Consultants, Indianapolis, Indiana. 12Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio. 13Western Slope Endocrinology, Grand Junction, Colorado. *ATA Public Health Committee Liaison. ATA Clinical Affairs Committee Liaison.

Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131I: Practice Recommendations of the American Thyroid Association (PDF File, 163 KB)

Address correspondence to:
James C. Sisson, M.D.
Division of Nuclear Medicine Department of Radiology
University of Michigan Health System
Ann Arbor, MI 48109-0028
E-mail: jsisson@umich.edu

This article has been revised since its original release in the April 2011 issue of Thyroid. Changes made subsequent to the April 2011 printing are presented in boldface. Correction date: May 19, 2011.