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


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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Dr Wieczorek             | ARSAC Licence Holder     |                                                           |   2024-08-23           |

====== REF008 - Radioiodine Ablation (Ca Thyroid) 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 ablation is the principal treatment following thyroidectomy of residual or recurrent differentiated thyroid cancer[([[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]])]. It is used for selective irradiation of thyroid remnants, microscopic differentiated thyroid cancer (DTC) or other nonresectable or incompletely resectable DTC, or both purposes [([[https://pubmed.ncbi.nlm.nih.gov/18670773/|Guidelines for radioiodine therapy of differentiated thyroid cancer, Luster, M et al. Eur J Nucl Med Mol Imaging 2008 Oct;35(10):1941-59]])]. The radioiodine is in the form of a capsule and is administered orally. This is performed in an inpatient setting with the patient having to isolate in the radioiodine suite on Ward 31 for up to four days (exact time depends on administered activity and clearance from the patient). Following discharge, the patient will 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 =====
Whilst an inpatient, the patient must remain in the radioiodine suite on Ward 31.

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 being isolated as an inpatient or 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 Clinical Oncologists may refer however referrals will have to be authorised by one of the ARSAC licence holders listed above.

===== Contraindications =====
^ Absolute  | • Pregnancy \\ • Breastfeeding  |
^ Relative  | • Bone marrow depression, if administration of high I131 activities is intended[(#2)] \\ (The EANM guidelines[(#2)] do not define “high I131 activities” but the SNM guidelines[(#1)] refer to the need for detailed dosimetry for patients treated with >7GBq) \\ • Pulmonary function restriction, if a significant pulmonary I131 accumulation is expected in lung metastases[(#2)] \\ • Salivary gland function restriction, especially if I131 accumulation in known lesions is questionable[(#2)]  \\ • Presence of neurological symptoms or damage when inflammation and local oedema caused by the treatment of the metastases could generate severe compression effects[(#2)]  |

===== Clinical Indications =====

| Therapy of residual thyroid cancer, local and distant metastases [(#1)][(#2)]  |
| Post-operative ablation of benign thyroid remnant after thyroidectomy [(#1)][(#2)]  |

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