Radioiodine therapy with 131 Iodine
In this form of therapy, the patient receives radioactive iodine (131Iodine), which is stored in the thyroid gland but cannot be used to produce thyroid hormones: It destroys the enlarged thyroid cells due to the radioactive radiation. Thus, hormone-producing cells are destroyed and the excessive hormone production is reduced. This therapy option can be considered for the following patients: Patients in growth age or pregnancy as well as breastfeeding period should not receive radioiodine therapy.
Likewise, this form of therapy is not suitable (= contraindicated) for persons with suspected malignant thyroid tumors.Possible side effects of radioiodine therapy may include radiation thyroiditis (radiation-induced thyroiditis), hypothyroidism or hyperthyroidism. After radioiodine therapy, the patients’ thyroid function is checked regularly (initially closely, later annually), because a possible hypothyroidism can still develop years after the therapy.
- Patients with Graves’ disease
- In the presence of autonomic thyroid gland areas
- In case of a recurrence (=recurrence) of hyperthyroidism despite thyroidectomy
- If an operation cannot be performed on the patient
- If there is a steadily worsening endocrine orbitopathy
Therapy of endocrine orbitopathy
Local measures can be taken to prevent the cornea from drying out: moistening eye drops or a watch glass bandage that keeps the eye moist when the patient can no longer close the eyelid. In addition, the eye socket can be irradiated orand therapy with corticosteroids (e.g. cortisone) to inhibit the autoimmune inflammatory reaction in the eye socket can be performed.
Complications
The thyrotoxic crisis or coma (=loss of consciousness) are complications of hyperthyroidism. This condition often occurs after the administration of iodine-containing drugs or contrast media for X-ray diagnosis or after discontinuing thyrostatic drugs that restricted the function of the thyroid gland. The crisis or coma in hyperthyroidism occurs in three stages: In stage I, patients have an increased heart rate of more than 150 beats per minute or atrial fibrillation.
They sweat more, lose a lot of fluid (exsiccosis) and have temperatures up to 41°Celcius. Patients vomit and have diarrhea, they are also very restless and tremble. It impresses a muscle weakness.
In stage II, in addition to the symptoms mentioned above, the affected patients are disoriented, have impaired consciousness and do not react adequately to external stimuli (=somnolent). Stage III is characterized by an additional coma, which can be complicated by circulatory failure. Patients with thyrotoxic crisis must be treated with intensive care, as they have a severe clinical picture.
The causal therapy is the rapid inhibition of excessive hormone synthesis, which is achieved by the intravenous administration of thyrostatic drugs. In the case of life-threatening iodine poisoning, the blood plasma can be washed in the form of plasma pahresis or a surgical procedure can be performed to almost completely remove the thyroid gland. The therapy of the symptoms consists of the administration of liquid, salts (=electrolytes) as well as calories via infusion.
In addition, ß-receptor blockers are given to treat the increased heart rate and high blood pressure, and the fever should be lowered with physical measures such as the application of cold. To prevent thrombosis, drugs are administered to prevent thrombosis (e.g. acetylsalicylic acid: ASS 100).