TRH (Thyroid Releasing Hormone) Test for Secondary Hypothyroidism
A TRH test may be indicated if secondary hypothyroidism is suspected. Some patients may have low levels of circulating thyroid hormones and secondary hypothyroidism as a result of damage to the hypothalamic or pituitary control mechanisms that regulate thyroid function. The hypothalamus makes a small hormone called TRH that directs the synthesis and secretion of TSH from the pituitary gland. If these normal regulatory mechanisms are interrupted, the pituitary may not be able to produce appropriate levels of TSH and levels of thyroid hormones may decline, although the TSH remains appropriately normal.
The TRH test involves administration of a small amount of TRH intravenously, following which levels of TSH will be measured at several subsequent time points using samples of blood taken from a peripheral vein. Patients with normal function of the hypothalamic-pituitary axis (HPA) respond by increasing the levels of TSH following TRH injection. Patients with compromised HPA function may exhibit a delayed, blunted, or absent response to TRH administration.
TRH may cause nausea, vomiting and some patients experience an urge to urinate. Rarely, TRH may cause blood vessel constriction leading to hemorrhage in patients with pre-existing pituitary tumors. Accordingly, patients should be advised about the risks, albeit rare, of TRH testing.
What to Expect from Radioactive Iodine (RAI) Treatment
You will be told to avoid iodine in your diet (salt, fish, seaweed, etc.) for a few days to a week before the RAI. The idea is to make any residual thyroid tissue hungry for iodine so that it absorbs as much of the RAI as possible. You will also need to be off of all thyroid medications for the same reason.
There are different approaches, depending upon your diagnosis. Many doctors will put you on Cytomel or some other form of T3 medication while you heal following your surgery and before the RAI. T3 meds are also known as "fast-acting" thyroid medication because it is quickly integrated by the body and is also quick to be metabolized.
Alternatively, Synthroid and other T4-only meds break down to T3, T2, T1, etc. as the body uses it. It takes 4-6 weeks for the body to balance after a dosage change of T4, but since Cytomel/T3 is already a breakdown product of T4 you don't have this waiting period.
So...they put you on Cytomel for a month or so before the RAI so you're not too hypo. Then they take you off the Cytomel for a week or so prior to the RAI to minimize the length of time you'll be uncomfortable. But, again, it depends on your diagnosis.
The weeks of hypothyroidism were uncomfortable, but at least they were temporary. Here's a short list of what I experienced:
Fibromyalgia-type pain including
- Body and Muscle Ache (mostly my back)
- Sore Legs
- Difficulty Walking (it got to where I could only shuffle along at one point)
Carpal Tunnel-type pain in hands and arms
Feeling cold all the time
Fatigue and feeling lethargic
Puffy, swollen face
Lack of coordination/vertigo
The good news is that I found Acupuncture to be a tremendous, immediate relief for the body ache/carpal tunnel/fibromyalgia pain. I was still able to work and function normally, but I tried not to push myself too much. Since I live in New York, I didn't have to drive anywhere, but the subway stairs took on a new meaning.
Your dosage will vary, depending upon whether the RAI treatment is for hyperthyroidism or for post-surgery thyroid cancer. For post-surgery RAI treatment, you are typically hospitalized for 1-2 days, but it depends on how low they want your radiation levels to be before you return home. I don't have children so, for me, it was an overnight hospitalization. Depending on how young your children are, they may have you stay longer.
Depending upon your dosage, you may experience some nausea. But keep drinking water and you will flush away the RAI quickly and return to feeling normal.
VERY IMPORTANT Bring sour, long-lasting hard candies (such as sour balls or lemon drops). You should eat these candies for at least the first 24 hours after receiving your radiation dose. Sour candy keeps the salivary glands productive, and you want to keep the radiation from settling in those glands.
I brought a laptop computer, a book, a really big hot/cold mug, and a water filter pitcher and electric kettle with instant soups and teas and snacks (nuts, dried fruit, etc.) that I like. (I brought the water filter pitcher because I remembered from surgery that the hospital tap water tasted funny.) I also brought comfy sweats so I didn't have to wear hospital gowns. I suggest bringing socks, comfy pajamas or a long-sleeve shirt/sweatshirt and sweatpants because the radiation can sometimes make you cold. A watch or travel clock is a good idea, too, so you can keep it by your bedside.
You can bring any food or clothing you want with you, but don't plan to take it home. The nurses will visit you intermittently to bring food and check your levels, but you're generally on your own. Hopefully, your room will have a window (mine did) so it doesn't really feel isolating.
They place lead shields around your bed (sort of like bedrails, except not attached), and you'll have to walk to and from the bathroom along a paper runner like a bride. They will ask you to sit when urinating and to flush the toilet twice. They were not happy about my bringing the electric kettle but they pretended not to know it was there. It was extremely helpful for me because I was able to drink gallons and gallons of water and soups without having to call for assistance.
When you go home, you'll be told not to get too close to children and not to let pets sleep on you for about a week. (They give you a list of instructions.) I slept in a separate room from my husband. Clothes that I wore in the hospital and at home, plus sheets etc. had to be soaked and washed several times before they could be placed with other clothing.
Then you usually stay hypo for a short time longer as they tend to do a follow-up thyroid scan within a few days of your hospital release. (You're already radioactive, so they just have to do the test.)
It passes quickly, I promise.
[This message has been edited by moderator1 (edited 10-07-2003).]
Preparation for a New Doctor / Endocrinologist Visit
Symptoms of thyroid disease are subtle (particularly when looked at individually instead of as a group). To make things worse, modern culture has taught us to view many of these symptoms as "unimportant" and, worse, psychosomatic. Because of this, it is easiest to receive good medical treatment by preparing for that doctor's visit.
Before your doctor's appointment, compile as much information as you can. At a minimum, this should include:
1) A list of your symptoms and how they've changed over time
2) The medications and any supplements or herbs you are taking (and when you started taking them)
3) How your body reacts to various medicines, supplements, foods, etc.
4) Copies of any blood or other tests you have had completed
You may want to compile this information in a notebook and keep it current for future visits. It will give you something to refer to -- if you have a recurrence of symptoms, you will be able to look back to what your blood levels were at the time, or even read notes to yourself about how you resolved the problem the last time it occurred.
Review all pages of this Information Archive thread. It includes a Symptoms Checklist that you can print out and present to your doctor (1/5/01 for the Hypo symptoms, 5/6/01 for Hyper symptoms), links about Hashimoto's and other forms of thyroiditis (7/28/01), a link about smoking and thyroid (8/1/01), a Q&A to use to interview potential new doctors (11/2/01), 2 posts about antithyroid antibodies and selenium (2/12/02), and a ton of other useful things.
Write out a list of questions for your doctor. At a minimum, ask the following:
1) The proposed approach to treating you
2) What you should expect
3) When you should see some results
4) What course of treatment may be suggested if the initial efforts don't work (combining T4 and T3 meds, switching you to a different type of medicine such as Armour or Naturethroid, etc.).
5) Supplements you should consider taking (Vitamin B-complex, Selenium, Calcium/Magnesium/Vitamin D, Antioxidants such as Vitamins C and E, etc.)
Stay persistent. Ask for copies of all test results to keep in your notebook. You will get better by becoming your own advocate.
[This message has been edited by ArtfulD (edited 07-30-2002).]
Here is some information (from a commercial source) about Iodine Content in Foods:
Good sources of iodine include vegetables grown in iodine-rich soil, kelp, onions, milk, milk products, salt water fish and seafood. The iodine content of vegetables varies widely with the iodine content of the soil in which they are grown. The table below can be used as a guide.
Sodium or potassium iodide is added to table salt in many countries including the USA, Switzerland, Australia and New Zealand. Salt used in the processing and refining of foods is not usually iodized.
Potassium iodate is used in the baking of some bread.
[code] Foods Serving Size Iodine Content
Cod 150g 165 mcg
Fish fingers 75g 75 mcg
Herring 150g 48 mcg
Kipper 150g 107 mcg
Mackerel 150g 255 mcg
Mussels 150g 180 mcg
Pilchards in tomato sauce 100g 64 mcg
Plaice 150g 42 mcg
Sardines, canned in oil 150g 35 mcg
Trout 150g 24 mcg
Tuna 150g 21 mcg
Whiting 150g 100 mcg
Cockles 50g 80 mcg
Prawns 150g 42 mcg
Scampi 150g 62 mcg
Cheese 40g 18 mcg
Milk 560g 86 mcg
Yogurt 150g 95 mcg
Beer 560g 45 mcg
Eggs 70g 37 mcg
Bacon 150g 18 mcg
Kidney 150g 23 mcg
Liver 150g 22 mcg
Potato chips 265g 13 mcg[/code]
The average iodine intake in the USA is over 600 mcg per day.
Recommended dietary allowances
Men 150 mcg
Women 150 mcg
Pregnancy 175 mcg
Lactation 200 mcg
Men 140 mcg
Women 140 mcg
Men 150 mcg
Women 120 mcg
Pregnancy 150 mcg
Lactation 200 mcg
[This message has been edited by moderator1 (edited 10-07-2003).]
Maca is a type of Peruvian turnip that is rich in many vitamins and minerals (including iodine). I'm finding that most websites won't quote actual RDAs of the vitamins and minerals present, as it varies with each root, so I can't verify if the website that says it's "rich in iodine" is more correct than the website that says it contains "traces of iodine."
Many foods contain iodine. I have not seen Maca promoted as an iodine supplement. My use of Maca has not altered my blood chemistry, but if you are concerned about your iodine intake, discuss it with your doctor.
A commercial website says:
Active constituents: Dried maca weighs in at about 60% carbohydrates (starches and sugars), 9% fiber, and slightly more than 10% protein. It has a higher lipid (fat) content than other root crops (2.2%), of which linoleic acid, palmitic acid, and oleic acid are the primary fatty acids, respectively. Maca is also a rich source of sterols, including sitosterol, campestrol, ergosterol, brassicasterol, and ergostadienol. From a mineral standpoint, maca exceeds both potatoes and carrots in value, and is a good source of iron, magnesium, calcium, potassium. Maca also contains iodine, manganese, copper, phosphorus, zinc and sodium and is a good source of amino acids and of vitamins B1, B2, B12, C and E.
Another website quotes the following, but doesn't indicate the amount of Maca to which this applies. My guess would be that this is the expected breakdown of nutrients in 500 mg of Maca (the typical amount in one capsule):
Raw Energy (Kcal) 334
Calcium 258 mg
Phosphorous 189 mg
Iron 15 mg
Selenium 2 mcg
B2 0.39 mg
B6 1.14 mg
C 286 mg
Niacin 5.65 mg
Plus iodine, saponins, natural estrogen, etc.
[This message has been edited by ArtfulD (edited 07-09-2002).]
Many of us get hives in association with our thyroid disease.
For me, it occurs when my medication is too high
and I am hyper because my skin temperature was very hot.
Others get hives when hypo.
I think it can occur for both.
I tend to stay away from antihistamines, but I tried several things that helped a bit.
For me, the worst areas were where my clothing was tight (undergarments, waistband, etc.)
so I tried to wear loose clothing. I also found
that scratching made it worse, but it's difficult
not to scratch sometimes.
Moisturizing also helped. I'd used Calendula
ointments for heat rashes before, and they helped
some with these hives. My favorite comes in a 1 oz white plastic tub and contains
Calendula-Coneflower-Comfrey in a cream form.
The other things that worked really well were
HCl/Camphor anti-itch ointment that Aveeno
makes and, as the hives began to respond, I
alternated with an MSM cream.
Most of these products can be purchased in a
Natural Food store. The Colloidal Oatmeal product
can be found in any drug store.
My hives lasted about two weeks. Hope yours go
[This message has been edited by moderator1 (edited 10-07-2003).]
Why some tests for Thyroid Cancer are not 100% Accurate
With most cancers, lump biopsies will reveal
the nature of the tissue and are therefore
quite accurate. Thyroid cancer is different.
An FNA Biopsy (Fine Needle Aspiration)
is an excellent tool but is not 100% accurate.
Fluid is removed from around the nodule(s)
and examined under a microscope for abnormal
cells. However, if there is too little fluid,
the biopsy may be inconclusive, because
there was nothing to view. If there are very
few abnormal cells present and the fluid was
removed from an area without abnormalities,
the biopsy may yield a falsely negative
result. A third possibility is when there are
cells that are suspicious for some of
the types of thyroid cancer, but there is not
a clear result.
A Thyroid Scan can determine if a nodule
is "cold" (does not produce thyroid
hormone), "warm" (produces normal amounts
of thyroid hormone just like the gland tissue),
or "hot" (produces an excessive amount
of thyroid hormone). Cold nodules are more likely
than warm or hot to have abnormal cells, but not
all cold nodules are cancerous. So the scan is
not 100% certain either.
[Other factors that increase the likelihood of
cancer include having a firm, fixed, irregular
nodule; sudden onset of hoarseness; firm
and/or swollen lymph nodes in the neck; etc.]
The Frozen Section biopsy that is
conducted during surgical removal of a nodule
is also not 100% accurate. This procedure is
done while the patient is in surgery to get a
quick diagnosis and determine how the surgery
should proceed (total thyroidectomy or close
the incision). The nodule is dipped in liquid nitrogen, it is sliced thin, and the slice is
viewed under a microscope for abnormal cells.
Again, if the area that is being studied does
not have abnormal cells, the frozen section
biopsy can yield a false negative result.
After the nodule (and/or thyroid gland) is
removed, the pathologists do a Total
Dissection and evaluation. It takes a
couple of weeks for results, but it typically
the only truly accurate way to tell if cancer
However, (besides the total dissection which
has 20/20 hindsight) all of the previous
diagnostic procedures are helpful and, when
taken together, the doctors can make a fairly
accurate deduction whether cancer is present
and can recommend appropriate next steps.
Don't let the fact that they're not 100%
accurate prevent you from having these studies
For additional information, here's a good page
about FNA & nodules:
[This message has been edited by moderator1 (edited 12-18-2002).]
The following user gives a hug of support to ArtfulD:
On The pros and cons of T3... Actually, I believe there are no cons if you need T3 and take it at the right dose. Here goes:
A healthy thyroid gland makes BOTH T4 and T3 among other things (see the reference I linked to below for more information). T4 is converted by various tissues including the liver into T3. Most doctors assume that this conversion process is enough T3 for the body and that no more is needed. The problem is that for many of us, the conversion is not as efficient, and we need some additional T3. This could be due to liver problems, selenium deficiency, extreme low-carb dieting or many other things.
The Pros are:
T3 is much faster acting than T4 and stabilizes in your blood much faster.
T3 is able to penetrate tissues that T4 cannot and can be used by some tissues that cannot use T4. T4 can't do it all.
T3 is active in the process of protein synthesis (ie making muscle tissue and repairing numerous body tissues. It is overused by some bodybuilders for this reason.)
T3 helps with mood by enabling certain neurotransmitters to do their job efficiently. T3 is often prescribed by Psychiatrists for this very reason.
T3 helps with energy levels in most people who need it.
It only takes a small amount of T3 to be beneficial in most cases, and many doctors overprescribe the amount. Start by lowering your dose of T4 slightly and then adding only 5mcg of Cytomel a day for a few weeks, adjusting from there.
T3 is used by the body faster and because of this, it works better if dosed two to three times a day for many people, though some do just fine on once a day.
If you DON'T need T3 or you are prescribed too much, you can go hyper very quickly. Not fun.
T3 suppresses TSH more than T4 in many people making the TSH test unreliable for them.
There are some tissues that T3 can't cross (The blood/brain barrier for one) and T4 is still necessary. This isn't actually a con, but an inllustration that T3 can't do it all.
Those are the pros and cons I can think of right off. There are many more pros than cons if the medication is given in the right dose and monitored properly. Monitoring should be done by measuring Free T3 and Free T4 as well as the standard (but outdated and not as useful) TSH test. If your doctor isn't monitoring at LEAST T3 levels, then s/he has little business prescribing it. It is my opinion that no hormone should be supplemented unles the levels of it are being monitored directly.
Gail's Thyroid tips located here has some good info on the role of T3: [url="http://home.usaa.net/~wurmstein/"]http://home.usaa.net/~wurmstein/[/url]
I am not a doctor, nor have I ever played one on TV...
For those of us taking Iron supplements, here is some useful information about sources and overdose symptoms. Remember, you must take your Iron supplements at least 2-4 hours separate from your thyroid meds.
Organ meats, extra lean red meats, dried fruits, cooked dried beans and peas, dark green leafy vegetables, fish, poultry, prune juice and oysters are excellent sources of iron.
Whole grain breads and cereals, green peas, strawberries, tomato juice, Brussels sprouts, winter squash, blackberries, nuts and broccoli also count as good sources of this mineral.
Herbs that contain iron include alfalfa, burdock root, catnip, cayenne, chamomile, chickweed, chicory, dandelion, dong quai, eyebright, fennel seed, fenugreek, horsetail, kelp, lemongrass, licorice, milk thistle seed, mullein, nettle, oat straw, paprika, parsley, peppermint, plantain, raspberry leaf, rose hips, sarsaparilla, shepherd’s purse, uva ursi and yellow dock.
Non-heme iron obtained from vegetable, fruit and grain sources is better absorbed if it is eaten at the same meal with a small amount of meat (heme iron) or vitamin C rich food.
Infants should be given breast milk or fortified milk formulas, as these are a better source of iron than cow’s milk.
Note: Food preparation methods affect the iron content of the food. Acidic foods, such as spaghetti sauce and tomato-based soups, prepared in cast-iron cookware can increase the iron content of the meal 300-fold. As iron leeches during prolonged cooking and is lost if the cooking water is discarded, cooking time and water content should be kept to a minimum.
Acute overdose: Nausea, constipation or diarrhea (in excess of 30 mg).
Chronic overdose: Hemosiderosis, hemochromatosis (a hereditary disorder of iron metabolism that causes bronze skin pigmentation, cirrhosis of the liver, diabetes, and heart disorders), production of free radicals, a rise in the need for vitamin E, heart disease and cancer.
What to do: For an acute overdose, call your doctor, emergency medical services (EMS), or the nearest poison control center immediately. For symptoms of chronic overdose, contact your doctor.
POSSIBLE SIDE EFFECTS
Talk to your doctor about any side effect that seems unusual or which is especially bothersome.
Avoid iron supplements if you are suffering from an infection. Infections are caused by bacteria, which need iron to grow. The liver stores iron deposits in the body during this time in order to prevent bacteria proliferation. Thus, iron supplements would result in an increase in the growth of bacteria. Iron can be fatal to children if taken in an overdose. Children should not be given iron unless prescribed by a physician for a particular disorder.
[This message has been edited by ArtfulD (edited 08-10-2002).]
Some doctors believe that the AM cortisol should be above 15 (per the recommendation of Jeffries in his book "The Safe Uses of Cortisol"). Some less agressive ones think that 12 is the magic cutoff point (Per Teitlebaum in his book "From Fatigued to Fantastic").
On an ACTH Stim Test, agressive doctors treat like this:
first draw: If not above 15, supplement with low dose cortisol. Above 15, look at the next draw.
second draw (30 minutes after ACTH injection): if not at least double the first draw, treat with low-dose cortisol. If double or more, all is OK.
third draw (60 minutes after ACTH injection): Should be significantly higher than the second draw, but not necessarily double if I remember correctly.
Sometimes a fourth draw is done, but is less significant. What is sometiems seen in the fourth draw is whether the adrenals give a delayed response. In someone with adrenal fatigue, the adrenals work, but you don't see the rise until much later, which could indicate a problem. Some docs see this rise later and say that it is OK. I don't believe that it is OK. Besides, RARELY do they do the 90 minute draw anyways.
I am not a doctor, nor have I ever played one on TV...
You're Having a Thyroiditis Flare
Some patients who have the autoimmune condition known as Hashimoto's thyroiditis are diagnosed during a period when they are hypothyroid. But in a thyroid that is failing due to autoimmune disease, the thyroid can frequently sputter into overdrive, then back into underactivity, and into overdrive again, as it "burns itself out" over time. You can, therefore, experience periods of overactivity - hyperthyroidism - even while your thyroid is underactive over time and generally on its way to burning itself out. So, you can experience hypothyroidism symptoms, but periodically have hyperthyroidism symptoms that also appear. And remember...hyperthyroidism symptoms don't "cancel out" your hypothyroidism symptoms...they more often are added to them.
At the same time, Hashimoto's can also mean that periodically, the thyroid experiences a flare-up, or "attack" of thyroiditis, which is frequently accompanied by symptoms such as palpitations. Noted thyroid expert Stephen Langer, M.D., who coauthored the popular thyroid book Solved: The Riddle of Illness with James Scheer, refers to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms you might experience are anxiety, panic attacks, heart palpitations and problems sleeping. - all common hyperthyroidism symptoms - as well as swelling in the thyroid area, and problems swallowing.
What Can You Do?
Generally, whatever the cause, some patients find relief from palpitations and rapid heartrate with beta blockers. Antianxiety drugs may also be a help in panic attacks and anxiety. Some patients find that they require treatment for particularly troublesome hyperthyroidism symptoms. For example, during periods when palpitations or high pulse become bothersome, drugs such as beta blockers - which lower heart rate and blood pressure and can slow or stop palpitations -- can be prescribed to help control symptoms. Sometimes, anti-anxiety drugs can be a help, and in some people, temporary use of sleeping pills may also be of assistance. On the natural end, some patients find that yoga, biofeedback, or breathing exercises can help with palpitations or rapid pulse.
One of the best treatments for dysautonomia symptoms is regular physical exercise, which calms down and regulates the autonomic nervous system. Palpitations are also responsive to acupuncture treatments. From a more nutritional medicine perspective, Dr. Langer suggests that patients experiencing thyroiditis and having trouble sleeping take calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation -- buffered aspirin or ibuprofen -- before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.
Reducing swelling is another key aspect of dealing with thyroiditis attacks, according to Dr. Langer. Says Langer: "Just as with arthritis, an anti-inflammatory pain reliever doesn't cure the problem, but it temporarily ameliorates the symptoms."
When it comes to palpitations, Dr. Langer feels that they can be misunderstood.
What happens with Hashimoto's patients having thyroiditis attacks is that many wind up in the emergency room seeing cardiologists. It happens a few times and then they're written off as psychiatric cranks. They end up with large doses of anti-anxiety medications or antidepressants.
Frequently, when not misdiagnosed as a heart problem, anxiety, or depression palpitations may be misinterpreted as a sign that a patient is getting too much thyroid hormone. But when medical evaluation rules out hyperthyroidism due to too much thyroid medication, mitral valve problems, or other cardiac abnormalities, Dr. Langer has found that nutritional deficiencies may be to blame -- in particular, deficiencies of calcium, magnesium or Vitamin D. Says Dr. Langer:
There's compelling evidence coming to the surface that Vitamin D is not only a vitamin but a hormone...The recommended daily allowance for Vitamin D is 400 IU, but scientists doing studies actually believe that people who do not get regular exposure to sunshine should be getting 2000-4000 Vitamin D. The Vitamin D also has profound effects on absorption of calcium and magnesium.
Here's a thyroid storm. From a medical textbook, The 4th edition of Emergency Medicine (eds. Tinhiralli, J., Buiz, E. and Krome, R.L. Some parts are quotes, some speedy summations.
"Thyroid storm is a RARE complication of hyperthyroidism in which manifestations of thyrotoxicosis are exaggerated to life-threatening proportions. Thyroid storm is most often seen in a patient with moderate to severe antecedent Grave's' disease and is usually precipitated by a stressful event. "
Precipitating Factors listed as primarily as infection, especially pulmonary infection, ketoacidosis in diabetics, hyperosmolar coma . . . Events possibly to initiate storm in vulnerable person: RAI, premature withdrawal of ATDs, use of an iodinated constrast medium during x-ray, thyroid hormone overdose, vigorous palpation of the thyroid gland . . . can also be vascular accidents, pulmonary emboli, toxemia of pregnancy and emotional stress.
Signs and Symptoms:
"The earliest signs are fever, tachycardia, diaphoresis, increased CNS activity, and emotional lability If condition is untreated, a hyperkinetic toxic state ensures in which symptoms are intensified. Progression to congestive heart failure, refractory pulmonary edema, circulatory collapse, coma and death may occur within 72 hours.
Fever ranges from 100.4-105.5. The pulse rate may range between 120 and 200 beats per minute but has been reported as high as 300 . . . sweating so profuse as to lead to dehydration from insensible fluid loss . . .
Central nervous systems . . . vary from restlessness, anxiety, emotional lability, manic behavior, agitations and psychosis, to mental confusion, obtundation and coma . . . cardiovascular abnormalities . . . increased stroke volume, cardiac output, etc . . .
Some people will receive their RAI dose and be sent home.
Some will stay in the hospital for 24hrs.
Some will stay longer, until the radiation risks are lowered.
Either way, you will have 2-4 days where you will want to take extreme precautions, and then about a week of taking more moderate precautions. I will refer to these the extreme precautions as the "In Hospital Isolation" period, and the more moderate precautions as the "At Home" period.
Each hospital is different. Some will let you take things home IF they aren't too radioactive. Others will make you leave everything there. Call them, ahead of time, and question them. That way, you'll know what you'll have to leave behind. There is a link on my main page, to a list of questions to ask your Nuke Med Dept.
If you are allowed to take things home, remember that clothes CAN be washed and most items can be left in a bag, in storage for a couple of months and be just fine. It's easier, though, to buy cheap silly things to take with you, and leave them there for the hospital to throw out.
BEFORE GOING TO HOSPITAL FOR YOUR RAI TREATMENT
There are a few things you might want to prepare at home, for when you return.
1. If you are returning within the first 24 hrs, have LID foods ready and waiting.
2. Take all extra things, which you don't want to irradiate and have to wash carefully, off your bed. No sense contaminating things that are hard to wash.
3. Set aside your own towels, dishes, glasses, etc. Hopefully, you will arrange a private bedroom and bathroom, where you can keep your supplies away from others.
4. Have cleaning supplies ready, i.e. sink brush, Lysol, wet wipes, or whatever will make it easiest for you to wipe down areas you've used.
5. Have a separate telephone for YOU to use for the first week. Cover the mouth piece with plastic wrap.
6. Have a toothbrush which you can throw out after the first week.
7. Gather any other helpful supplies, such as disposable plates & utensils, surgeon's or food handlers' gloves, tissues, plastic bags for used tissues, plastic bags for radiated laundry.
8. If you are the food preparer in the family, stock up on store bought or homemade meals for the others in your family, so that YOU will not have to prepare meals for them. You shouldn't be handling their food, and you probably won't have the energy to do it, anyhow. And for goodness sakes, if anyone says, "Let me know if I can help..." be sure to tell THEM to bring meals.
9. Leave all valuables at home....purse, jewelry, watch, wallet, etc.
10. Take your insurance card!!!! But then give it to your friend or family member to take home. Better yet, take a photo copy of your card (front and back) and just give it to the admittance people.
11. Put out the cloths you want to wear home from the hospital. Have the person who is picking you up bring these to the hospital on the last day.
12. REMINDER!!! If you need pre-certification to be an in-patient and have your insurance cover it...be sure someone calls for this ahead of time!
EMPTY SMALL PLASTIC TRAVEL BOTTLES with your favorite shampoo, conditioner, lotion, etc....so you can throw out what you don't use
TALL PLASTIC DRINK GLASS, rather than the mini-hospital ones
POWDERED LEMONADE(check the label for LID)
COMFY PAJAMAS OR NIGHTSHIRTS that you're willing to leave there
PEN/PENCIL to make notes to tell nurse/doctor next time they appear
PAPER and/or POST-IT NOTES to write or draw on...or to put messages on your window for people to see from the outside, or on the door of your room.
BATH SOAP that YOU like
DECK OF PLAYING CARDS
ROOM FRESHENERS (Some places make you keep your food trash...so it can get rather ripe.)
CHEAP UNDERWEAR that you would NEVER wear anywhere else, or want to take home.
FUNKY SLIPPERS or furry socks...again, that you'd never wear anywhere else, can leave there, but will feel happy and warm in.
SMILEY FACE STICKERS....just to remind you to smile
GINGER for nausea (Chinese ginger candy, ginger ale, homemade LID ginger snaps, or ginger capsules for motion sickness from health food store)
GREETING CARDS: Ask friends and well wishers to give you funny or inspirational cards and messages, but don't open them until you get into isolation. Then space them out so you have mail every hour.
Collect internet jokes from people, and space THEM out to read when you need a laugh.
LISTERINE, in case you get thrush...it helps to use it before using the medicine that will be prescribed.
ICE CHEST!!!! Take your own LID snacks, drinks, etc.
Have someone cater LID meals, if the hospital will let you. There's no sense being hungry, and the hospitals usually don't have a clue about what constitutes a low iodine diet.
PHONE NUMBERS of friends and family...written on something you can throw away/
LONG DISTANCE CALLING CARD information
EYE GLASSES....leave your contact lenses at home. You won't want to mess with them and it's probably not a great idea to use them because they hold fluids next to your eye.
PLASTIC BAGS: Take your supplies in a plastic bag or a box that you don't need again. You won't want to irradiate your favorite suitcase. Also, if you are asked to keep your food trash in your room, you'll like having extra bags to double-bag the trash.
***If you wear the hospital gowns, you can wear one tied in back and then wear another one as a robe (tied in front). A little less skimpy in the rear.
***Have your clean, good clothes removed from the room and brought back when it's time to leave.
AT HOME REMINDERS
After the first 48 hours, you will still want to take precautions, even though your radiation levels will be greatly reduced. Remember two main rules:
1. CONTROL BODILY FLUIDS (first 7 days after RAI)...especially saliva. Avoid kissing and sexual activities. Do not let anyone else share your eating utensils. Control spraying from sneezing or coughing. Be careful with anything you put in your mouth, including pencils you chew on.
2. MINIMIZE EXPOSURE (first 5 days after RAI...but 7 days for being around pregnant women or children): When in doubt, increase your distance from others, and reduce your time with them.
Continue to flush 3 times.
If others are using your toilet and sink area, be sure to wipe it down after use and keep your toothbrush and glass in a separate area.
Continue to sleep alone for 5-7 days, post RAI.
At the end of the week, wash all bed linens and clothes that you wore while "glowing".
When the week is over, all you have to do is try to remember what "Life before RAI" was like, and go live it!
May your thyca be zapped, and may YOU continue to glow with the radiance of EXCELLENT HEALTH ! !
This was all helpful for me when I had RAI June of 2002 Hope this helps someone else.. May God Bless You All...marcia