March 16, 2024

1400H - 1500H
Via Zoom

Empowerment
objective - for laypeople
to have an essential
CAN ONE SKIP understanding on
RADIOACTIVE WHETHER ONE CAN
IODINE THERAPY SKIP RADIOACTIVE
IN THYROID IODINE THERAPY IN
CANCER THYROID CANCER
TREATMENT? TREATMENT as part of
their health
management.
 March 16, 2024
1400H - 1500H
Via Zoom
Welcome all!

Empowerment MUTE yourself but always

objective - for laypeople show your video picture.

to have an essential Sign in your name, FB

CAN ONE SKIP understanding on account, or email address in
RADIOACTIVE WHETHER ONE CAN the Chat Box! Include names
of companions attending.
IODINE THERAPY SKIP RADIOACTIVE
IN THYROID IODINE THERAPY IN Use the Chat Box to ask
CANCER THYROID CANCER questions and make
comments while the PEP TALK
TREATMENT? TREATMENT as part of is on.
their health
management. There will be group pictures
at start and end of PEP TALK –
show your face in video.
Reminder after the PEP
Talk:

Take the Online Learning

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Link is in Chat Box.

Reminder:
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Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:
Empowerment
objective - for laypeople FEEDBACK TO THIS
to have an essential PEP TALK!
CAN ONE SKIP understanding on
RADIOACTIVE WHETHER ONE CAN Pls. type in your
IODINE THERAPY SKIP RADIOACTIVE feedback in the chat
IN THYROID IODINE THERAPY IN box during the open
CANCER THYROID CANCER forum and before we
TREATMENT? TREATMENT as part of adjourn!
their health
management. Thank you!
 LET’S NOW HAVE A
Empowerment GROUP PICTURE
objective - for laypeople TAKING BEFORE WE
to have an essential START PEP TALK
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RADIOACTIVE WHETHER ONE CAN MINUTES!
IODINE THERAPY SKIP RADIOACTIVE
IN THYROID IODINE THERAPY IN Pls. turn on your
CANCER THYROID CANCER video!
TREATMENT? TREATMENT as part of Show your face!
their health
management.
 Empowerment
ROJoson PEP Talk
objective - for laypeople
to have an essential
I have a Patient
CAN ONE SKIP understanding on
Empowerment
RADIOACTIVE WHETHER ONE CAN
Program in which I
IODINE THERAPY SKIP RADIOACTIVE
like to empower the
IN THYROID IODINE THERAPY IN
lay people or
CANCER THYROID CANCER
patients to take
TREATMENT? TREATMENT as part of
control in the
their health
management of
management.
their health.
I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses.
This may take 3 years or
longer depending on our
enthusiasm, discipline
and perseverance.
We are now on our 3rd
year!
 Empowerment My PEP TALK today is
objective - for laypeople entitled:
to have an essential CAN ONE SKIP
CAN ONE SKIP understanding on RADIOACTIVE IODINE
RADIOACTIVE WHETHER ONE CAN THERAPY IN THYROID
IODINE THERAPY SKIP RADIOACTIVE CANCER TREATMENT?
IN THYROID IODINE THERAPY IN
CANCER THYROID CANCER
TREATMENT? TREATMENT as part of
their health
management.
 CAN ONE SKIP Contents Disclaimer:
RADIOACTIVE • What is RADIOACTIVE IODINE THERAPY (RAIT)?
IODINE THERAPY • How is RAIT used in thyroid cancer treatment? ROJoson PEP Talk
IN THYROID • Can one skip RAIT in thyroid cancer treatment? contains ROJoson’s
CANCER Thoughts,
TREATMENT? Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and other
professionals.
 CAN ONE SKIP What is RADIOACTIVE IODINE THERAPY (RAIT)?
RADIOACTIVE
IODINE THERAPY
IN THYROID
CANCER
TREATMENT?
 CAN ONE SKIP What is RADIOACTIVE IODINE THERAPY (RAIT)?
RADIOACTIVE
IODINE THERAPY Radioactive iodine therapy has been used in
IN THYROID the treatment of thyroid cancer since the early
CANCER 1940s.
TREATMENT?
But
What is it?
How does it work? Questions posed.
Which patients need it?
And how has its use changed over the years?
Can one skip it in thyroid cancer treatment?
 CAN ONE SKIP What is RADIOACTIVE IODINE THERAPY (RAIT)?
RADIOACTIVE
IODINE THERAPY Radioactive iodine therapy is a
IN THYROID radiopharmaceutical.
CANCER
TREATMENT? Radiopharmaceuticals are drugs that contain,
among other ingredients, radioactive forms of
chemical elements called radioisotopes (a
radioactive substance).

RAI, as a radiopharmaceutical, involves the use of

radioactive isotope, Iodine 131 (I-131).
 CAN ONE SKIP What is RADIOACTIVE IODINE THERAPY (RAIT)?
RADIOACTIVE
IODINE THERAPY Iodine-131 (I-131) is commonly used to treat
IN THYROID hyperthyroidism and certain types of thyroid
CANCER cancers (papillary and follicular).
TREATMENT?
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY
IN THYROID
CANCER
TREATMENT?
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE There are 4 common types of thyroid cancers:
IODINE THERAPY - Papillary thyroid carcinoma
IN THYROID - Follicular thyroid carcinoma
CANCER - Medullary thyroid carcinoma
TREATMENT? - Anaplastic thyroid carcinoma

RAIT is only used for well-differentiated thyroid

carcinomas — specifically, PAPILLARY AND
FOLLICULAR THYROID CANCERS.

Medullary and anaplastic thyroid carcinomas will

not benefit from RAIT.
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY Well-differentiated thyroid malignancies retain
IN THYROID the ability to absorb iodine (thus, the radioactive
CANCER iodine)
TREATMENT? that can destroy the cancer cells
making RAIT an effective therapeutic
intervention.

Sodium iodide I-131 induces cellular necroptosis

(cell death) through beta emission.
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY Common indications of RAIT in well-differentiated
IN THYROID thyroid cancers being down in the community:
CANCER
TREATMENT? • remnant ablation
• adjuvant therapy
• treatment of known disease
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY Remnant ablation refers to the destruction of
IN THYROID presumably benign thyroid tissue remaining after
CANCER total or subtotal thyroidectomy.
TREATMENT?
Remnant ablation promotes the accurate
interpretation of postoperative I-131 whole-body
imaging and serum thyroglobulin levels, https://
mitigating confusion between what may be www.ncbi.nlm.nih.gov/
books/NBK580567/
residual remnant thyroid tissue, local disease #:~:text=Well
recurrence, or metastatic disease. %2Ddifferentiated
%20thyroid
%20malignancies
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY Adjuvant treatment refers to additional therapy
IN THYROID after surgery to lower the risk of cancer
CANCER recurrence in patients with an intermediate or
TREATMENT? high risk of recurrence.

It is claimed that adjuvant therapy improves the

progression-free survival in patients with no https://
obvious evidence of disease but the possible www.ncbi.nlm.nih.gov/
books/NBK580567/
presence of subclinical micrometastases. #:~:text=Well
%2Ddifferentiated
%20thyroid
%20malignancies
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY Treatment of known disease refers to destroying
IN THYROID known residual cancer or recurrent structural or
CANCER biochemical disease.
TREATMENT?
This shall be done with curative or palliative
intent. The therapy is said to improve
progression-free and overall survival. https://
www.ncbi.nlm.nih.gov/
books/NBK580567/
#:~:text=Well
%2Ddifferentiated
%20thyroid
%20malignancies
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY How is RAIT given?
IN THYROID
CANCER I-131 is supplied in capsule or liquid form for
TREATMENT? patients to swallow.

It is quickly absorbed into the bloodstream in the

gastrointestinal (GI) tract. It is concentrated from
the blood by the thyroid gland, where it begins
destroying the gland's cells. It also can kill cancer
cells that may present in the neck or elsewhere.
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY How is RAIT given?
IN THYROID
CANCER Hospital confinement is usually needed to isolate
TREATMENT? a patient under RAIT. Duration of stay averages 3
to 4 days (depends on how quickly the RIA leaves
the body).
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY What are the side effects of radioactive iodine
IN THYROID therapy?
CANCER • Hypothyroidism (usually permanent)
TREATMENT? • Neck tenderness and swelling
• Nausea
• Swollen salivary glands
• Loss of taste or taste change
https://
• Dry mouth/insufficient salivary production my.clevelandclinic.org/
• Dry eyes health/treatments/16477-
• Excessive tearing from the eyes radioiodine-radioactive-
iodine-therapy
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY What precautions should be taken with
IN THYROID radioactive iodine therapy?
CANCER • Women who are pregnant or nursing should
TREATMENT? not receive RAI therapy.
• Pregnancy should be delayed at least six to 12
months after RAI treatment for thyroid cancer.
• Breast feeding should be stopped at least six
https://
weeks before RAI and should not be resumed. my.clevelandclinic.org/
health/treatments/16477-
radioiodine-radioactive-
iodine-therapy
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY What precautions should be taken with
IN THYROID radioactive iodine therapy?
CANCER In the days immediately following your RAI
TREATMENT? therapy, be aware of these general precautions to
prevent radioactive exposure to others.
• Avoid prolonged, close physical contact with
others, especially children and pregnant
https://
women. my.clevelandclinic.org/
• For the first few days stay a distance of at least health/treatments/16477-
6 feet away from others. Avoid public places. radioiodine-radioactive-
iodine-therapy
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY What precautions should be taken with
IN THYROID radioactive iodine therapy?
CANCER In the days immediately following your RAI
TREATMENT? therapy, be aware of these general precautions to
prevent radioactive exposure to others.
• Sleep alone in a separate bed (at least 6 feet
away from another adult).
https://
• Do not share kitchen and cooking utensils, my.clevelandclinic.org/
bedding, towels and personal items with health/treatments/16477-
others. radioiodine-radioactive-
iodine-therapy
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY What precautions should be taken with
IN THYROID radioactive iodine therapy?
CANCER In the days immediately following your RAI
TREATMENT? therapy, be aware of these general precautions to
prevent radioactive exposure to others.
• Do dishwashing and laundering of the items
you use separately.
https://
• Wash your hands often and shower daily. my.clevelandclinic.org/
health/treatments/16477-
radioiodine-radioactive-
iodine-therapy
 CAN ONE SKIP How is RAIT used in thyroid cancer treatment? 2020 information
https://
RADIOACTIVE medicalpricesdatainph.wor
IODINE THERAPY What are the expenses in RAIT? (PH) dpress.com/2020/03/11/
IN THYROID post-thyroidectomy-
radioactive-iodine-therapy/
CANCER • Cost of I-131 (depending on dosage)
TREATMENT? • Hospital Stay
• Professional Fee

• With or without PhilHealth

• With Senior Discount / PWD

• Average: P50K as of 2020 (without the

discount benefits yet)
 CAN ONE SKIP 2020 information
https://
RADIOACTIVE medicalpricesdatainph.wor
IODINE THERAPY dpress.com/2020/03/11/
IN THYROID post-thyroidectomy-
radioactive-iodine-therapy/
CANCER
TREATMENT?

79000 Radiopharmaceutical (radioactive iodine) therapy 3,640 2,800

79005 Radiopharmaceutical ablation of gland for thyroid carcinoma or
metastases of thyroid carcinoma 8,020 5,500
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY
IN THYROID
CANCER
TREATMENT?
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment? Context of health issue:
RADIOACTIVE A lot of physicians are
recommending RAI in the
IODINE THERAPY
treatment of thyroid
IN THYROID cancer in a ritualistic and
CANCER maximalist approach.
TREATMENT?
Ritualistic – habit with no
critical analysis
Maximalist – inclusive of
non-essential need
Minimalist – only the
essential need

What could b a
minimalist approach?
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY How has radioactive iodine therapy evolved
IN THYROID over time?
CANCER A decade ago, RAIT is given to everybody — even
TREATMENT? someone with the smallest papillary carcinoma.
But review of the data shows that not all patients
need it. There may be no need to treat all thyroid
cancers, as most grow slowly and patients have
excellent outcomes with surgery alone. https://www.mdanderson.
org/cancerwise/radioactive
-iodine-therapy--9-things-to
-know.h00-159466368.html
2021
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY How has radioactive iodine therapy evolved
IN THYROID over time?
CANCER So now, there is a leaning more towards giving
TREATMENT? less radioactive iodine therapy and doing less
aggressive surgeries. Particularly if there’s a very
low risk of recurrence, one may recommend only
a partial thyroidectomy — or removal of a part of
someone’s thyroid gland — and not give them https://www.mdanderson.
org/cancerwise/radioactive
radioactive iodine therapy at all. -iodine-therapy--9-things-to
-know.h00-159466368.html
2021
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY One can skip RAIT in thyroid cancer
IN THYROID treatment if the risk of recurrence after
CANCER
surgery is low.
TREATMENT?

If there is complete removal of the well-

differentiated thyroid cancers during
surgery (in the thyroid gland and also in
the neck nodes if present).
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment?
RADIOACTIVE
IODINE THERAPY One should not skip RAIT in thyroid cancer
IN THYROID treatment if the
CANCER
• risk of recurrence after surgery is high
TREATMENT?
(such as incomplete removal)
• there is distant metastasis
• there is a recurrence that has a high
risk for recurrence after surgical
removal of the recurrence
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment? A word on common
RADIOACTIVE practice of remnant
IODINE THERAPY Remnant ablation can refer to the destruction of ablation using RAIT.
IN THYROID normal thyroid tissue remaining after a subtotal
CANCER thyroidectomy was done for thyroid cancers. The
TREATMENT? implication is that grossly the thyroid cancers
have been removed completely. However, the
operation was not a total thyroidectomy.
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment? A word on common
RADIOACTIVE practice of remnant
IODINE THERAPY Remnant ablation will just be done to promote ablation using RAIT.
IN THYROID the accurate interpretation of postoperative I-131
CANCER whole-body imaging and serum thyroglobulin
TREATMENT? levels to mitigate confusion between what may
be residual remnant thyroid tissue, local disease
recurrence, or metastatic disease.
 CAN ONE SKIP Can one skip RAIT in thyroid cancer treatment? A word on common
RADIOACTIVE practice of remnant
IODINE THERAPY Personally, I don’t go for remnant ablation of the ablation using RAIT.
IN THYROID normal thyroid tissue using RAIT just to facilitate
CANCER interpretation of the postoperative I-131 whole-
TREATMENT? body imaging and serum thyroglobulin levels.

NOTE: the assumption is that there is complete

removal of the well-differentiated thyroid cancers
even after a subtotal thyroidectomy.

This is one of the indications that one can SKIP

RAIT in thyroid cancer treatment.
 CAN ONE SKIP Contents
Summary
RADIOACTIVE • What is RADIOACTIVE IODINE THERAPY (RAIT)?
IODINE THERAPY • What is RAIT in thyroid cancer treatment? Take Away
IN THYROID • Can one skip RAIT in thyroid cancer treatment?
CANCER
TREATMENT?
 CAN ONE SKIP Be always in touch with reliable medical
Take Away in
RADIOACTIVE information on WHETHER ONE CAN SKIP
IODINE THERAPY RADIOACTIVE IODINE THERAPY IN THYROID relation to
IN THYROID CANCER TREATMENT?. Patient
CANCER Empowerment
TREATMENT? Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on WHETHER
ONE CAN RADIOACTIVE IODINE THERAPY IN
THYROID CANCER TREATMENT? as part of your
health management.
 Empowerment This ends my PEP
objective - for laypeople
TALK today on:
to have an essential
CAN ONE SKIP understanding on CAN ONE SKIP
RADIOACTIVE WHETHER ONE CAN RADIOACTIVE IODINE
IODINE THERAPY SKIP RADIOACTIVE THERAPY IN THYROID
IN THYROID IODINE THERAPY IN CANCER TREATMENT?
CANCER THYROID CANCER
TREATMENT? TREATMENT as part of
their health
management.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:
Empowerment
objective - for laypeople FEEDBACK TO THIS
to have an essential PEP TALK!
CAN ONE SKIP understanding on
RADIOACTIVE WHETHER ONE CAN Pls. type in your
IODINE THERAPY SKIP RADIOACTIVE feedback in the chat
IN THYROID IODINE THERAPY IN box during the open
CANCER THYROID CANCER forum and before we
TREATMENT? TREATMENT as part of adjourn!
their health
management. Thank you!
 LET’S NOW HAVE A
Empowerment GROUP PICTURE
objective - for laypeople TAKING BEFORE WE
to have an essential START Q&A AND
CAN ONE SKIP understanding on INTERACTIONS!
RADIOACTIVE WHETHER ONE CAN
IODINE THERAPY SKIP RADIOACTIVE Pls. turn on your
IN THYROID IODINE THERAPY IN video!
CANCER THYROID CANCER Show your face!
TREATMENT? TREATMENT as part of
their health
management.