RE: Thyroid radiation doses are much too high

[Carol Marcus <csmarcus@ucla.edu>]

At 02:22 PM 3/8/2004, Neil, David M wrote:

>A question, re the discussion of Graves disease.  If the objective is 

>total removal of thyroid tissue, wouldn't the protocol likely be surgical 

>removal of the gland, with radioiodine given after to ablate any stray tissue?

>

>This would seem to be both more efficient and more in line with ALARA.





Dead wrong.  In the first place, radioiodine treatment of Graves' disease 

and certain other types of hyperthyroidism was developed to avoid surgery, 

which has morbidity and mortality associated with it.  In the second place, 

ALARA is an indefensible idea unless you are dealing with levels of 

radiation that can be definitively shown to cause real harm.  Even if there 

was harm from the radiation, which there is not in this case, the harm 

would have to be weighed against the harm of surgery and associated 

anesthesia.



There are about 60 years of basic and clinical literature on the subject of 

I-131 and hyperthyroidism.  You might start with an elementary nuclear 

medicine textbook.



Carol S. Marcus, Ph.D., M.D., ABNM, FACNP

Prof. of Radiation Oncology and of Radiological Sciences, UCLA

President, ACNP-California