A multi-dose vial of radioactive iodine with a pill containing one dose. Radioactive iodine is used to treat cancers and thyroid disease. (University of Utah Health)
Estimated reading time: 6-7 minutes
SALT LAKE CITY — Shirley Crepeaux was a little hesitant when doctors suggested radioactive iodine as a treatment for her thyroid cancer about 12 years ago. She trusted her doctors at the Huntsman Cancer Institute, but she was still terrified and afraid.
“When faced with leaving a 12-year-old boy and my widowed husband alone or drinking some poison, I’m going to drink some poison,” she said.
Crepeaux, now 54, is a mother of four. When he was diagnosed with cancer, his youngest was 12 years old.
“We tried to make the cancer diagnosis a big non-event as much as we could,” he said.
The radioactive iodine treatment, however, was definitely an event.
She was given a small bottle to drink from while alone in a specific room and was given many warnings over a speaker system telling her not to spill or drop it. He said it tasted salty.
After drinking it, he was told to stay away from pregnant people and children for a week. He spent a week in his bedroom. Crepeaux said she was “pretty miserable,” but her husband did everything he could to help her stay in touch with family, including video calls at the breakfast table and waves through the window.
“In the grand scheme of things, it was a week out of my life and then I was back to myself,” she said.
How it works
Thyroid cancer is one of the most common cancers and one of the easiest to treat, in part because of radioactive iodine.
Dr. Dev Abraham of the Huntsman Cancer Institute said radioactive iodine was first used in the 1930s and 1940s, around the same time chemotherapy was being developed, and the treatment became popular in the 1960s. Treats thyroid cancers and disorders and Graves’ disease, which causes the thyroid to overproduce hormones.
“It has stood the test of time,” Abraham said.
What has changed over time is the dose, Abraham said, and there have been more reports recently showing a small but statistically significant increase showing that too much radioactive iodine can lead to a higher risk of other cancers, causing the doses to be reduced. the last five to 10 years.
Radioactive iodine is administered in a capsule or drink, and Abraham said it’s a unique targeted treatment. Thyroid tissue, including thyroid cancer tissue that has spread throughout the body, will be destroyed by the treatment once it enters the cell. Other cells that come into contact with radioactive iodine in the blood will not be affected.
“It’s a treatment that’s specifically determined by the tissue’s ability to capture, collect, or trap iodine. So tissues that trap iodine are specifically susceptible to being killed by this low-grade radioactivity,” Abraham said.
Before taking a dose of radioactive iodine, doctors like Abraham will help a patient starve thyroid tissue and thyroid cancer of iodine by avoiding certain foods to make those cells hungry and absorb more iodine. radioactive
Most often, the treatment is used after much of the cancer has been removed in surgery to address leftover thyroid tissue that might have cancer cells or cancer cells that have spread, which is more common in thyroid cancers than in many other cancers.
He said that in many cancers, spread to other areas leads to a worse prognosis. But with radioactive iodine, the spread of thyroid cancer does not necessarily mean a worse prognosis.
Abraham said that while one death is too many, not many patients die of thyroid cancer. The American Cancer Society estimates that there will be about 43,800 new cases of thyroid cancer in 2022 and about 2,230 deaths.
The main goal of radioactive iodine is to reduce the frequency of thyroid cancer recurrence, he said.
Crepeaux continues to have appointments with Abraham every year, said he’s been taking care of her for years and it looks like she’ll continue to do very well and the radioactive iodine treatment was effective.
Crepeaux is one of the few thyroid cancer patients who have residual disease, small amounts of cancer that do not grow. Abraham said these are likely dying thyroid cancer cells, and in most patients, cancer cells that remain but do not progress are as good as a cure.
Due to radioactive iodine treatment, Crepeaux constantly suffers from dry nose, throat and eyes. She said she always carries her water bottle with her and uses products to add moisture.
Abraham said this is one reason why treatment should be tailored to the patient, using the smallest effective dose. He said two doses are sometimes used in severe cases, but rarely three.
If the cancer returned and Crepeaux decided to take a second dose of radioactive iodine, she said that would lead to no tears, spitting or saliva, even more discomfort.
Crepeaux was a hairdresser for 30 years, but is now going to school to become a medical assistant.
“That’s something that happened to me. I’m not who I am. I’m Shirley and I’ll always be Shirley. A little salty. A little sassy… I don’t take anyone’s joke. And if I love you. , I love you with everything…I will not let cancer or anything else change that or define me,” she said.
She said it was thanks to her primary doctor that she was screened for thyroid cancer. If he hadn’t, he might have died within a few years. When he was found, it was between stage three and four and had already spread to his lungs. Her only symptom up to that point had been shoulder pain and difficulty swallowing.
Now, Crepeaux encourages everyone to feel for thyroid lumps by doing self-checks, or asking their doctor to check during an annual physical.
Crepeaux was told after the surgery that she would have a very hoarse, hoarse voice, but therapy and her high voice helped save her voice, although she said it now takes a lot more effort to produce a voice audible
“Fortunately, I was one of those people with a really strong voice before the surgery, so now I just have a normal voice,” she said.
His laugh, however, is still the same loud laugh, a laugh that elicits more laughter from others in the room.
Overall, Crepeaux shared a message that there is hope and encouraged others going through similar situations to be grateful and focus on the little things that bring them happiness.
“Most people with cancer live with it, they don’t die with it,” he said.