Differentiated Thyroid Cancer Therapy Administration
Radioiodine is given orally on an inpatient basis. Currently a solution of sodium iodide may be employed or more conveniently the use of a capsule containing the radiopharmaceutical. The former has to be handled and given to the patient with extreme care to prevent contamination, problems not seen in the case of the capsule, which is more expensive. Refer to Dose Estimation for the amount to give.
Check patient's ID and dose to give. Detail in written form radiation protection directions to patient, during the hospitalization and at discharge.
Usually in the second day and in case of nausea and eventually vomiting, administer separate doses of ondansetron 4 mg or 8 mg iv. every 6 h. Alternatively, an infusion with 16 mg ondansetron plus KCl 1 gr in a solution containing glucose 5% and saline 1 lt every 12 h can be given. Likewise Methoclopramide, 1mg/kg/24h divided in doses every 6 h in 100 ml saline to run in 1 h to 4 h, may be used. For some patients it is more effective and could be better tolerated, 100 ml saline with 10 mg domperidone, every 8 h or 6 h to run in 1 h to 4 h.
Also in the second day and as a preventive indication to avoid the inflammation and later damage to the salivary glands, it is advisable for patients to take acid juices, or savor acid candies to increase saliva secretion and excrete the radioiodine. This is more frequent with doses over 100 mCi (3.7 GBq).
In some cases in which the oral route is hazardous, I-131 iodine can be administered intravenously (3).
References:
1 Jairo Wagner, Anneliese F. Thom, Lilian Yuri Itaya Yamaga. Tratamiento del Cancer Diferenciado del Tiroides con Radio Yodo, P: 193 -201 In: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.
2 Meier D.A. et al. Therapy of Thyroid Disease with Iodide-131 (Sodium Iodide) V1.0 Society of Nuclear Medicine Procedure Guideline. 2002: 1-11.
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