131 THERAPY FOR HYPERTHYROIDISM. Radiology Associates of Clearwater

Transcription

1 OUTPATIENT I-I 131 THERAPY FOR HYPERTHYROIDISM Radiology Associates of Clearwater INDICATIONS: Treatment of diffuse or nodular hyperthyroidism. SCHEDULING: (Front Desk to confirm insurance authorization prior to scheduling therapy. Review checklist and comply.) 1. Instructions to Patients: a. The patient must not have taken PTU or Tapazole for five days. The patient should be off Synthroid for at least four weeks. b. All patients should be instructed to avoid excessive iodine intake for weeks before therapy (no shellfish): c. No iodinated radiographic contrast materials for at least 4 weeks (CT, angiograms, IVP, cardiac cath, oral cholangiograms - gall bladder test). d. Obtain authorization from insurance company. 2. Special Considerations: a. Review all requests for radioiodine therapy for hyperthyroidism with the nuclear medicine physician well in advance of the scheduled day. Usually, the nuclear medicine physician will wish to speak directly with the referring physician. b. Prepare a "red therapy file". This is to contain reports of any scans or therapies done in the Nuclear Medicine Department, copies of signed consent forms, physician notes, and copies of pertinent records and laboratory values.

2 c. Usually, a radioiodine uptake test will be performed immediately before radioiodine therapy and, frequently, a thyroid scan will be performed. Schedule as follows, and review with patient: (1) Day 1: 1 "Consult" - the nuclear medicine physician will meet with the patient to discuss indications, anticipated goals, potential side effects, alternatives, instructions to follow at home, and plans for follow- up care. The consent form will be reviewed and a signed. Make a copy for the patient. Have departmental nurse obtain vital signs. A capsule will be administered for RAIU (or scheduled in near future), unless previous RAIU at MPMHC within 30 days. (2) Day 2: 2 RAIU value will be determined and, a if requested, Pertechnetate scanning will be performed. The nuclear medicine physician will meet again with the patient for any follow- up questions. The physician will notify the lab tech as to the appropriate dose to order. (3) Day 3: 3 The patient will return for administration of radioiodine. advance. The dose must be ordered 24 hr in 3. Lab: At the time of scheduling, obtain from the referring doctor's office any recent thyroid laboratory test results (particularly TSH and T4). Unless specifically okayed by the nuclear medicine physician, fertile women must have a beta- HCG test within seven days before therapy. studies. physician. Obtain any outside reports of recent thyroid imaging Obtain clinical note (within 60 days) from referring 4. Image Correlation: All prior thyroid images, including RAIU and scan, and ultrasound report. RADIOPHARMACEUTICAL:

3 I-131 sodium iodide in capsule form, mci orally, as specified by the nuclear medicine physician. PATIENT PREPARATION: Again confirm that: 1. No iodinated contrast has been given within weeks. 2. Patient has been off Synthroid for four weeks. 3. Patient has been off PTU and Tapazole days. 4. Low iodine diet. 5. Pregnancy status. PROCEDURE: 1. The nuclear medicine physician will meet with the patient to discuss the therapy, and instructions to follow at home. Consent form and Home Instruction sheets should be available for physician to review at the time of consultation. 2. Use the dose calibrator to confirm that the proper therapy dose has been received. The technologist and verifier are to initial the dose record at the appropriate sites. Quality Management therapy sheets must be filled in and signed by technologist and verifier. The dose must be within ±10% of the ordered dose. 3. Before administration of dose, verify that the informed consent form has been signed, and that (if ordered) the beta- HCG is negative. Put the signed "CONSENT FOR RADIOIODINE THERAPY OF HYPERTHYROIDISM" in the red therapy file. name, SSN, and DOB. Verify patient 4. Administer the radioiodine capsule orally. Follow this with at least 4-8 ounces of water and two saltines, to ensure clearance of the capsule from the esophagus.

4 REFERENCE: W.H. Beierwaltes. Semin. Nucl. Med. VIII(1): , The treatment of hyperthyroidism with Iodine Burman, Ken. Endocrin. Clin. N. Amer. JSM PROTOCOL COL\ 10-1 Rev. 10/14/14 Note: This procedure has not yet been reviewed by the Society of Nuclear Medicine procedure guideline development process. CONSULTS: All hyperthyroid therapies. All thyroid cancer patients new to Nuclear Medicine M when evaluation for therapy is requested. Samarium (or Strontium): Checklist to be returned by referring physician. Consult only if requested. Consent form to be signed. SCHEDULING: Samarium therapy (without consult) Wednesday and Thursday at 1:30 pm. All outpatient consults Monday- Friday, 9:00 am; minimum 48 hours advance scheduling. Required supporting documents must be available by 3 pm preceding day, otherwise appointment must be rescheduled no exceptions: Nuclear Medicine jacket with prior scans.

5 RX from referring physicians. Hyperthyroidism ICD : Most recent TSH, T4. Most recent clinical note from referring physician or H&P. 24- Hour RAIU at MPMHC only within 30 days, or at time of consult no exceptions. When applicable, BHCG pregnancy test within 7 days prior to treatment.* Operative report. Pathology report. Thyroid CA ICD : Most recent clinical note (or H&P). Off thyroid hormone for six weeks, with minimum TSH >35. BHCG, when n applicable, within 7 days prior to dosing (scan and Rx).* Request MPMHC inpatient record 24hr in advance to be in Nuclear Medicine prior to patient arrival. Samarium (Strontium- 89) ICD- 9 Bone mets 198.5: See checklist. ( Imperative tive: CBC, most recent therapeutic history, any bone scan within months, no current chemo/radiation.) * All menstruating females of childbearing age, unless waived by nuclear medicine physicians due to TAH/BSO etc.