RE: Thyroid radiation doses are much too high

["Neil, David M" <neildm@id.doe.gov>]

Apparently my thoughts were based on a misapprehension that the treatment required total thyroidectomy - which turns out not to be the case.  I was given the name and eddress of a prominent researcher into Graves Disease, who sent me an explanation of some of the issues.  In technical detail.  

 

This link provides an analog to my mental state :-)  http://freefall.purrsia.com/~color/ffstrip.php?num=215

 

I have a zoology degree, a fair amount of experience removing thyroids from dead game animals for bioassay, and at least some insight into thyroid function vis-a-vis radioiodine, but I know when I'm out of my depth.

 

Given my slightly improved level of knowledge on the subject, I can see that surgical removal would not be the treatment of choice in almost every case - but then that's why I asked the question.



-----Original Message-----

From: Carol Marcus [mailto:csmarcus@ucla.edu]

Sent: Monday, March 08, 2004 11:21 PM

To: Neil, David M; John Jacobus; Stabin, Michael; radsafe@list.Vanderbilt.Edu

Subject: RE: Thyroid radiation doses are much too high





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