Navigatng RAI

A frequently asked question is:
What are some of your best tips for navigating isolation in a house with a spouse and small children or pets?


Radioactive Iodine (RAI) is used to ablate (destroy) thyroid tissue and cells that remain following surgery for thyroid cancer. (It is also used to treat hyperactive thyroid disease.) Because thyroid cells attract iodine, the radiation can be targeted specifically to them. A low iodine diet beforehand, so thyroid cells are depleted of iodine, and avoiding exposure to others while undergoing treatment are important.

Guidelines about preparing for Radioactive Iodine (RAI) vary widely. Different institutions and providers make different recommendations and it can get pretty confusing. An individual’s circumstances – small children, pets, room mates, transportation can all affect how one should prepare and how much time is needed for the process.


My first thought in response to this particular question was “Have your spouse (partner, housemate) take the dogs (kids) for a vacation.” But it is true – clingy pets can sometimes be as difficult to deal with as young children. If you have a friend who loves your pups (or kids) and will take them on for a couple of days go for it.

Keep in mind that exposure is time and distance – a quick hug or a pat and a treat won’t cause harm but in general at least six feet and no prolonged exposure*. Walls and doors don’t stop radiation so I’d suggest a doggie gate for the pups and set the TV where you and others can watch together yet separated at least six feet apart.* 

You do need to sleep alone – If beds are on an adjoining wall, move them to maintain six feet of separation. You don’t need to wrap your bed in plastic but a mattress topper/pad that is moisture resistant (doesn’t have to be “waterproof”) and that you can launder with your sheets is sufficient. 


Any RAI not retained by thyroid cells is excreted in body fluids – urine, saliva, sweat, blood, bowel movements. Most will be cleared in the first 48-72 hours

You want the RAI to stick to any remaining or renegade thyroid cells, not in your breast tissue, salivary glands or GI or urinary tracts. Hydration will help flush the RAI through your system so it doesn’t linger where you don’t want it – so drink, pee, poop, flush three times, repeat. It’s recommended to drink a full glass of water every hour and empty your bladder every two hours.
Avoid getting constipated – you want that RAI moving out.

In the bathroom, flush three times to dilute the eliminated RAI – with the lid down to avoid aerosolizing the toilet contents; men should urinate sitting down. If you have to share a bathroom, wipe down surfaces your’ve touched after use. 

Avoid chlorine bleach as it can cause RAI on surfaces to become volatile (become airborne). This article from the Health Physics Society on cleaning products can be helpful.  Along that line, if you use continuous cleaners or “drop in” tablets for your toilet, I would remove them prior to RAI and leave them out for a week or so.

Dishes can go in the dishwasher, laundry in the clothes washer (no bleach) – run extra cycles or rinses. (You’re probably getting the idea by now that water is your friend.)

Try to limit stuff which will be thrown away. Any “disposable” items need to be stashed away for a month or two to allow any radiation present to further decay. Many waste facilities have radiation monitors so if you put stuff in the trash too soon you may get a notice from your trash collector.  Consider TP instead of facial tissues, washable cleaning cloths instead of paper towels, etc. Set a calendar reminder to eventually throw away the disposable items that you’ve hidden away.

If your housemate is not a chef or you live alone, do lots of pre-prepared meals so you don’t end up with take-out every night. Some people report feeling really tired after RAI – this is sometimes a side effect of any radiation therapy.  If you must do the food prep for others wear gloves and take advantage of the many pre-prepared meal options now available at the grocery store and online.

Stock up on sugar-free sour (usually lemon) candies to keep salivary glands working (RAI likes to hang out there and you want it gone).


Your provider should tell you how long you have to isolate – usually 3-5 days depending on the dose of RAI – so back to work might depend on what you do and if it puts you in close contact with small creatures. 

  • If you’re a preschool teacher or you work in an OB or pediatrician’s office you might want to wait a couple of weeks. 
  • If you work in an office or other setting around adults and can’t work from home then you’re OK when the radiology folks say you can end isolation. You might want to still avoid hugging pregnant women and babies and get someone else to make the coffee for a while. 
  • If you have small children or pets I would try to keep them off my lap an extra week or longer.  

Some people have gone to the expense of purchasing or renting a geiger counter. For most of us this is likely an unnecessary expense, but an interesting discussion on one person’s experience can be found here.


See your dentist for a thorough check up and cleaning before RAI and ask about what to do if you experience dry mouth following RAI.  Dental problems are frequently reported on discussion boards.

A few people may experience side effects with the Thyrogen shot. The Thyrogen website has detailed education and support information https://www.thyrogen.com/patients 
Your provider may suggest an anti-nausea medication such as Zofran (ondansetron) to be taken in the morning. It works best as a preventive to be taken before you experience any nausea.

Make sure your provider has told you when to resume your thyroid hormone replacement medication and when to schedule blood work. And that you have their emergency contact number for nights or weekends.

Finally, be aware that you may feel tired and isolated.  Try to take the opportunity to catch up on reading, movies or TV shows you’ve missed or just sleep. Don’t be afraid to let friends know you may need help with kids, pets or meals and be sure to make your provider aware if your circumstances will make it difficult for you to set up your isolation.


Special situations need to be discussed in depth with your provider. If you are pregnant, could possibly be pregnant or are nursing a baby RAI needs to be postponed. When planning a pregnancy, both men and women should wait at least six months following RAI.


SNMMI
Fact Sheet: Guidelines for Patients Receiving Radioiodine I-131 Treatment
https://www.snmmi.org/AboutSNMMI/Content.aspx?ItemNumber=5609

Health Physics Society – Specialists in Radiation Safety
Preparing for RAI
https://hps.org/publicinformation/ate/q13058.html
Cleaning Products
https://hps.org/publicinformation/ate/q11727.html

Interesting discussion regarding a Geiger Counter Experiment posted on Inspire Thyroid Cancer Connect
https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/my-rai-with-a-geiger-counter-experiment/?origin=freshen

ThyCa Support Groupshttps://www.thyca.org/sg/

*When working in hospital with patients undergoing radiation therapy, we were taught “six feet”; many sites recommend only three feed.