Iodine Therapy for Thyroid CancerProblem: Thyroid Cancer is a disease caused by abnormal cells growing in the thyroid gland, which is a butterfly – shaped gland in the neck that creates hormones to regulate body conditions. Thyroid Cancer is believed to be an uncommon cancer, despite having 56,870 cases as of 2017 in the US. Most people who have it do well, as it’s usually found and treated in early stages. If it returns, it can be treated again. One of the best solutions being using iodine 131 therapy (RAI). (Web MD, n.d.) (American Cancer Society, 2017) Experts don’t know exactly what causes thyroid cancer. All they know is that changes in the DNA of your cells play a role. These changes may include inherited ones as well as changes that happen over time. Exposition of radiation to the torso can also increase chances of getting thyroid cancer. (Web MD, n.d.) Even though thyroid cancer is uncommon as of now, research has shown that it is expected to steadily increase the number of people affected; with papillary thyroid cancer numbers  doubling by 2019 and it is also expected to become the 3rd most common cancer for women in future years. (American Cancer Society, 2017) Despite substantial clinical and economic burdens that this represents, thyroid cancer research remains underfunded at $14.7 million as of 2009 (in America).(Aschebrook-Kilfoy et al., 2013). Solutions:There are many possible solutions to thyroid cancer, one of them being chemotherapy. Chemotherapy uses anticancer drugs that are injected into the veins, muscles or are swallowed by the patient. It’s a systematic therapy, meaning that the drug enters the bloodstream to destroy cancer cells. However, this treatment has many side effects such as hair loss, nausea, muscle fatigue and so on. It’s also seldom helpful for most types of thyroid cancer. (American Cancer Society, 2016) (Cancer Research UK, 2014)Another possible solution is for the patient to get surgery. The most common procedure to get would be Thyroidectomy, to remove the entire thyroid gland. It’s done through an incision across the neck, and a prescription of daily levothyroxine (thyroid hormones) pills. There are still many risks and side effects,  including larynx irritation by the breathing tube during the surgery, damage to the parathyroid glands which can lead to muscles spasms and such, hematoma and more. (American Cancer Society, 2016) This treatment is sometimes used in combination with Iodine therapy. (American Cancer Society, 2016)(Radio)iodine therapy is a therapy for thyroid cancer that works as follows; your thyroid gland will take in the iodine present in your body, so when radioactive iodine (the radioisotope of I-131) is taken as a pill or liquid, it will end up in the thyroid gland. The radiation of the isotope can destroy the thyroid gland and any other possible cancer cells there as they take up the iodine, while having minimal effects on your body. (American Cancer Society, 2016) The short trajectory of emitted beta particles guarantees this. (De la Vaissière et al., n.d.)If an isotope has an uneven number of neutrons, it becomes unstable and the nuclei will split up in a process called radioactive decay and emit radioactive radiation.(BBC, 2014) In Nuclear medicine – where radioisotopes are used – there are three different types of radiation; Alpha particle emission that are made of two neutrons and two electrons; Beta particle emission, which can be either an electron or a positron, that has a shorter trajectory compared to gamma; and Gamma, which is an energy wave. (BBC, 2014) (John A., 2017)I-131 emits both Beta and Gamma (U.S.NRC, 2017), Gamma rays killing the cancer cells (10%), and Beta rays damaging the tissue (90%). (Wikipedia, 2017) (“10 Things to Consider before Having Radioactive Iodine Treatment,” n.d.) The treatment can also be used after a surgery to destroy any tissue not removed. Just the therapy alone is a common practice, known as RAI (Radioactive Iodine Ablation) therapy. It has been used since 1942 and it has improved the survival rate of many patients since then. (De la Vaissière et al., n.d.) It has temporary side effects such as neck tenderness and swelling, nausea, and swelling and tenderness of salivary glands, although chewing gum or candy help with the latter. I-131 is secreted out of the body with urine, but most patients stay in isolation until it has been secreted completely to avoid contamination. (ThyCa, 2017) (“10 Things to Consider before Having Radioactive Iodine Treatment,” n.d.)(Figure 1. Explains the process visually.)  I-131 itself is a radioactive isotope form of the more common iodine that can be found in food (most commonly in shellfish). (The American Association of Endocrine Surgeons, 2013) Isotopes are derived forms of a chemical element which vary in number of neutrons. This particular isotope has a half life of 8.02 days, one of the reasons why it is so radioactive, as that is the time it takes to release radioactive particles.(De la Vaissière et al., n.d.) Benefits and Limitations: Not dissimilar to other possible treatments RAI has benefits and limitations. As mentioned before, the possible side effects are a limitation, as well as cause of a thyroid storm with excess hormones and antibodies, the possibility of the radiation causing cancer (1 out of 10,000 chance), replacement hormones meaning people never feel ‘right’, the fact that it can only be used when thyroid cancer has high levels, (“10 Things to Consider before Having Radioactive Iodine Treatment,” n.d.), the fact that it is mainly only used for high-risk patients and how hazardous it is to the environment. However, it is still relatively effective as it has many benefits. These include: a quick and easy treatment with minimal risk (ThyCa, 2017), the relatively low amount of side effects compared to other treatments, relatively high effectiveness among patients compared to other patients with majority being cured by at least 1 year and it is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 80%,  (Ghadban et al., 2003) (Aschebrook-Kilfoy et al., 2013) and a short wait list for it in most countries. The way that it cures Thyroid Cancer is the most direct, destroying it from the inside, compared to surgery and chemotherapy. It does not have the exact scientific background that the former do, but the comparative advantages make it a more effective solution. Ethical impacts:DisadvantagesThere are still common misconceptions and ethical challenges among patients concerning RAI. Because there is so little known about thyroid cancer and RAI, patients feel the need to self-educate which leads to false information or falsely interpreted information. There are also cultural fears of RAI (based on history with nuclear weapons), so the general population always sees images of hair loss and birth defects when told ‘radioactive’ and ‘nuclear.’ This lack of understanding for RAI mean fewer consents to the treatment which in turn means that many people could be using RAI to cure themselves if the world would be more informed about it.  (Rosenthal, 2006) This also causes them to use more expensive and environmentally dangerous treatments, with 4 out of 5 people being afraid of nuclear treatment. (Gasser, 2017) AdvantagesHowever, the fact that people are becoming more educated about Radiation by use and spread of this therapy, makes them less afraid of medical use of radiation, which is also useful for other types of medication, such as CAT scans, X-rays and many more. At the moment, over 10,000 hospitals around the world have radioisotopes in medicines, and around 16 million people from the USA are now using radioactive medicine.(WNA, 2017) It is even stated that “Employment of nuclear medicine technologists is projected to grow 20 percent from 2012 to 2022, faster than the average for all occupations.” All of this could cause leaps in countries survival rate, medicine research and even the economy. (American Nuclear Society, 2017)Conclusion: To conclude, the treatment of Iodine (131) therapy is proven to be the most effective for thyroid cancer with multiple scientific studies to prove it. It directly attacks the cancer from the inside (‘killing’ it with beta and gamma rays) with minimal outside damage. With most of the general population (of thyroid cancer patients) deciding against use of nuclear medicine because of ethical challenges (dropping from 20 million cases to 17 million as of 2005 in the US) (Delbeke & Segall, 2011), it remains ignored, and the correct course of action will be to educate patients about the scientific knowledge of it. But, at this moment, the most sensible solution would be to combine the use of RAI and a Thyroidectomy, giving the patient the I-131 in pill form after the surgery to ensure the lack of cancer cells. This would be the most sensible solution right now because the patient wouldn’t be as afraid of it due to ethical reasons, and the end use of RAI would be effective and ensure results.


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