**Hull University Teaching Hospitals NHS Trust - Nuclear Medicine** 


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Uncontrolled if printed
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[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/examcodes/database.db|SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF007'|0]] 
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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|   Prof. Sathyapalan            | ARSAC Licence Holder     |    |  2024-08-23  |

====== REF007 - Radioiodine Treatment of Thyrotoxicosis Referral Criteria ======
See [[referral_criteria:ref000-how_to_refer_to_huthnm|REF000 - Referring to Nuclear Medicine (HUTH)]] for details of how to refer.

===== Description =====
Radioiodine therapy is a useful treatment for hyperthyroidism. In most cases it is the first-line treatment for solitary hyperfunctioning thyroid nodules or it can be administered if hyperthyroidism is not controlled or recurs after initial antithyroid drug treatment[([[https://pubmed.ncbi.nlm.nih.gov/20625722/|EANM procedure guidelines for therapy of benign thyroid disease. Stokkel MPM et al. Eur J Nucl Med Mol Imaging (2010) 37:2218–2228.]])]. The radioiodine is in the form of a capsule and is administered orally. This is performed in an outpatient setting with the patient having to subsequently follow radiation protection restrictions regarding hygiene and close contact for a period of time dependent on the prescribed activity.

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===== Radiation Protection Restrictions =====
Following the treatment the patient will be required to follow some radiation protection measures:
  * Good hygiene restrictions to prevent contamination with their bodily fluids
  * Close contact restrictions where they will have to distance from others to reduce the radiation exposure to them

If there is any reason to believe that the patient may have difficulties following these restrictions (e.g. if the patient has continence issues including use of a catheter and/or incontinence pads; requires assistance from carers or acts as a carer; or lives in a home not connected to mains drainage) please ensure the Nuclear Medicine department is informed and a note is included in the referral. Additional measures may be required in such cases and we may need to perform a radiation risk assessment before appointing the patient for treatment.

===== Staff Entitled to Refer =====
All UK Registered Endocrinologists may refer however referrals from individuals not listed below will have to be authorised by one of the ARSAC licence holders listed above.

| Dr Mo Aye  |
| Prof Thozhukat Sathyapalan  |
| Mr R. England  |
| Dr Shiva Mongolu  |
| Dr Kamrudeen Mohammed  |
| Mr Ashley Walden  |
| Dr Rehmat Karim  |
| Dr Sufyan Benamer  |


===== Contraindications =====

^Absolute:|Pregnancy[(#1)][([[http://bookshop.rcplondon.ac.uk/contents/pub208-bdbb4220-3a14-401a-b298-c0d3f20cdd38.pdf|Radioiodine in the management of benign thyroid disease: clinical guidelines. Report of a working party 2007]])] \\  Breastfeeding[(#1)][(#2)] |
^Relative:|Uncontrolled hyperthyroidism[(#1)] \\  Active thyroid orbitopathy (especially in smokers)[(#1)] |


===== Clinical Indications =====
| Hyperthyroidism (Graves’ disease, toxic multinodular goitre, solitary toxic thyroid nodule)[(#1)][([[http://snmmi.files.cms-plus.com/docs/I-131_V3.0_JNM_pub_version.pdf|The SNM Practice Guideline for Therapy of Thyroid Disease with 131I 3.0]])]  | 
| Non toxic multinodular/diffuse goitre [(#1)][(#3)]  |

The referral must indicate the prescribed activity of I-131 to be administered.