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RAI or not RAI?
This is probably the hottest question on the treatment of Graves' Disease (hyperthyroidism) today.
RAI is RadioActive Iodine treatment in which the hyperthyroid patient is given a "cocktail" with radioactive iodine which goes to the thyroid and destroys much of its function.
Most doctors in the U.S. push RAI very heavily and try to get their patients to undergo it ASAP. Most doctors in Europe don't push RAI but favor maintenance on antithyroid drugs (ATDs) because of the high rate of "spontaneous" remissions and the possibility that RAI causes permanent damage to the body and may significantly increase the risk of cancer.
I think RAI is barbaric and insane and should never even be considered. Hopefully someday it will lie among the skeletons in the medical treatment closet. I also think that getting the radioiodine uptake test is a mistake and can cause damage to the thyroid and eyes. I really don't see the need for performing it.
The Atomic Women are a group of women (and hopefully some men) who have undergone RAI and now regret it. Read about their thoughts. New website (11-29-00) (http://suite101.com/myhome.cfm/atomicwomen
Following is a quote from John Gofman. Please read his credentials because he is very knowledgeable about the use of radiation in medicine:
"In radiation research, nearly all the work is sponsored by the governments
which are defending and promoting nuclear power . . . Ionizing radiation may
well be the most important single cause of cancer, birth defects and genetic
disorders . . . The stakes for human health are very, very high in radiation
matters. It is essential that people take no chance that conflict-of-interest is producing radiation databases which cannot be
For more information on radiation, see:
Lancet1999 Jun 19;353(9170):2111-5
Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study.
Franklyn JA, Maisonneuve P, Sheppard M, Betteridge J, Boyle P
Department of Medicine, University of Birmingham, UK.
BACKGROUND: Radioiodine is used increasingly as first-line treatment for hyperthyroidism, but concerns remain about subsequent risk of cancer, especially in those treated at a young age. We investigated cancer incidence and mortality in patients treated with radioiodine for hyperthyroidism. METHODS: We did a population-based study in 7417 patients treated in Birmingham, UK, between 1950 and 1991. We compared details of all cancer diagnoses and deaths in 1971-91 from the UK Office for National Statistics with data on cancer incidence and mortality for England and Wales specific for age, sex, and period. FINDINGS: During 72,073 person-years of follow-up, 634 cancer diagnoses were made, compared with an expected number of 761 (standardised incidence ratio [SIR] 0.83 [95% CI 0.77-0.90]). The relative risk of cancer mortality was also decreased (observed cancer deaths 448, expected 499; standardised mortality ratio [SMR] 0.90 [0.82-0.98]). Incidence of cancers of the pancreas, bronchus, trachea, bladder, and lymphatic and haemopoietic systems was lowered. Mortality from cancers at all these sites was also reduced but findings were significant only for bronchus and trachea. There were significant increases in incidence and mortality for cancers of the small bowel (SIR 4.81 [2.16-10.72], SMR 7.03 [3.16-15.66]) and thyroid (SIR 3.25 [1.69-6.25], SMR 2.78 [1.16-6.67]), although absolute risk of these cancers was small. INTERPRETATION: The decrease in overall cancer incidence and mortality in those treated for hyperthyroidism with radioiodine is reassuring. The absolute risk of cancers of the small bowel and thyroid remain low, but the increased relative risk shows the need for long-term vigilance in those receiving radioiodine.
PMID: 10382695, UI: 99310068
Acta Endocrinol (Copenh)
Acta Endocrinol (Copenh)1990 Feb;122(2):233-40
Peripheral blood T cell activation after radioiodine treatment for Graves' disease.
Teng WP, Stark R, Munro AJ, Young SM, Borysiewicz LK, Weetman AP
Department of Medicine, University of Cambridge Clinical School, Addenbrooke's Hospital, UK.
Radioiodine therapy for Graves' thyrotoxicosis produces a rise in thyroid autoantibodies in the first three months after treatment, but little is known of its effects on T cells. We have therefore followed the changes in T cell subsets in sequential samples from 23 patients with Graves' disease treated with radioiodine, using dual-colour flow cytometry. In the first month after treatment there was a significant rise in activated T cells, identified by the markers HLA-DR (la) and CDw26/Ta1 (p less than 0.025 in both cases). CD45RO-positive T cells, which are the primed population containing memory cells, also increased (p less than 0.025), but there was no change in CD45R-positive, resting T cells or in the CD4 to CD8 (helper to cytotoxic/suppressor) ratio. Vicia villosa-binding T cells, containing the contrasuppressor population, showed a more variable response, but the trend was to an overall increase from pre-treatment values (p less than 0.025). The changes did not appear to be related to antithyroid drug treatment, since they were seen irrespective of whether patients continued such therapy. These results suggest that T cell activation and enhanced contrasuppressor activity may in part be responsible for the rise in autoantibodies after radioiodine. The T cell changes could also contribute to the worsening of ophthalmopathy seen in some radioiodine-treated patients.
PMID: 2316311, UI: 90195418
The following letter is from: email@example.com (Elaine Moore)
ATD's can be used during pregnancy, but there is a slight risk of
Stress reduction methods, either meditation, tai chi, or yoga and energy healing, like acupuncture, etc. are all of great value. Sometimes, though, there's lots of stress involved with trying to get everything right. Then, surgery is a viable option if your symptoms seem to be life threatening. By the way, your levels are high but not extremely high. What's important, though, is how much they have changed and if you're seeing improvement with your ATD's.
Following is a great, must-read historical review of the use of radiation in medicine. It's an unbelievable history and it makes you not want to be a part of it.
From: firstname.lastname@example.org (Julia)
Hi you all,
The Major Cause Of Cancer, Part 1
The ability to see inside the human body for the first time was a marvelous, mysterious and deeply provocative discovery. Roentgen trained X-rays on his wife's hand for 15 minutes, producing a macabre image of the bones of her hand adorned by her wedding ring. Roentgen's biographer, Otto Glasser, says Mrs. Roentgen "could hardly believe that this bony hand was her own and shuddered at the thought that she was seeing her skeleton. To Mrs. Roentgen, as to many others later, this experience gave a vague premonition of death," Glasser wrote.[1,pg.4]
Within a year, by 1896, physicians were using X-rays for diagnosis and as a new way of gathering evidence to protect themselves against malpractice suits. Almost immediately -- during 1895-96 -- it also became clear that X-rays could cause serious medical problems. Some physicians received burns that wouldn't heal, requiring amputation of their fingers. Others developed fatal cancers.
At that time, antibiotics had not yet been discovered, so physicians had only a small number of treatments they could offer their patients; X-rays gave them a range of new procedures that were very "high tech" -- bordering on the miraculous -- and which seemed to hold out promise to the sick. Thus the medical world embraced these mysterious, invisible rays with great enthusiasm. Understandably, physicians at thetime often thought they observed therapeutic benefits where controlled experiments today find none.
At that time -- just prior to 1920 -- the editor of AMERICAN X-RAY JOURNAL said "there are about 100 named diseases that yield favorably to X-ray treatment." In her informative history of the technology, MULTIPLE EXPOSURES; CHRONICLES OF THE RADIATION AGE, Catherine Caufield (see REHW #200, #201, #202), comments on this period: "Radiation treatment for benign [non-cancer] diseases became a medical craze that lasted for 40 or more years."[1,pg.15] "...[L]arge groups of people [were] needlessly irradiated for such minor problems as ringworm and acne.... Many women had their ovaries irradiated as a treatment for depression."[1,pg.15] Such uses of X-rays would today be viewed as quackery, but many of them were accepted medical practice into the 1950s. Physicians weren't the only ones enthusiastic about X-ray therapies. If you get a large enough dose of X-rays your hair falls out, so "beauty shops installed X-ray equipment to remove their customers' unwanted facial and body hair," Catherine Caufield reports.[1,pg.15]
Roentgen's discovery of X-rays in 1895 led directly to Henri Becquerel's discovery of the radioactivity of uranium in 1896 and then to the discovery of radium by Marie Curie and her husband Pierre in 1898, for which Becquerel and the Curies were jointly awarded the Nobel prize in 1903. (Twenty years later Madame Curie would die of acute lymphoblastic leukemia.)
Soon radioactive radium was being prescribed by physicians alongside X-rays. Radium treatments were prescribed for heart trouble, impotence, ulcers, depression, arthritis, cancer, high blood pressure, blindness and tuberculosis, among other ailments. Soon radioactive toothpaste was being marketed, then radioactive skin cream. In Germany, chocolate bars containing radium were sold as a "rejuvenator."[1,pg.28] In the U.S, hundreds of thousands of people began drinking bottled water laced with radium, as a general elixir known popularly as "liquid sunshine." As recently as 1952 LIFE magazine wrote about the beneficial effects of inhaling radioactive radon gas in deep mines. Even today The Merry Widow Health Mine near Butte, Montana and the Sunshine Radon Health Mine nearby advertise that visitors to the mines report multiple benefits from inhaling radioactive radon, even though numerous studies now indicate that the only demonstrable health effect of radon gas is lung cancer.
Thus the medical world and popular culture together embraced X-rays (and other radioactive emanations) as miraculous remedies, gifts to humanity from the foremost geniuses of an inventive age.
In the popular imagination, these technologies suffered a serious setback when atomic bombs were detonated over Japan in 1945. Even though the A-bombs arguably shortened WW II and saved American lives, John Hersey's description of the human devastation in HIROSHIMA forever imprinted the mushroom cloud in the popular mind as an omen of unutterable ruin. Despite substantial efforts to cast The Bomb in a positive light, radiation technology would never recover the luster it had gained before WW II.
Seven years after A-bombs were used in war, Dwight Eisenhower set the U.S. government on a new course, intended to show the world that nuclear weapons, radioactivity and radiation were not harbingers of death but were in fact powerful, benign servants offering almost-limitless benefits to humankind. The "Atoms for Peace" program was born, explicitly aimed at convincing Americans and the world that these new technologies were full of hope, and that nuclear power reactors should be developed with tax dollars to generate electricity. The promise of this newest technical advance seemed too good to be true -- electricity "too cheap to meter."
The Atomic Energy Act of 1946 created the civilian Atomic Energy Commission but as a practical matter the nation's top military commanders maintained close control over the development of all nuclear technologies.
Thus by a series of historical accidents, all of the major sources of ionizing radiation fell under the purview of people and institutions who had no reason to want to explore the early knowledge that radiation was harmful. In 1927, Hermann J. Muller had demonstrated that X-rays caused inheritable genetic damage, and he received a Nobel prize for his efforts. However, he had performed his experiments on fruit flies and it was easy, or at least convenient, to dismiss his findings as irrelevant to humans.
In sum, to physicians, radiation seemed a promising new therapy for treating nearly every ailment under the sun; for the military and the Joint Commmission on Atomic Energy in Congress it unleashed hundreds of billions of dollars, a veritable flood of taxpayer funds, most of which came with almost no oversight because of official secrecy surrounding weapons development; and for private-sector government contractors like Union Carbide, Monsanto Chemical Co., General Electric, Bechtel Corporation, DuPont, Martin Marietta and others -- it meant an opportunity to join the elite "military-industrial complex" whose growing political power President Eisenhower warned against in his final address to Congress in 1959.
Throughout the 1950s the military detonated A-bombs above-ground at the Nevada Test Site, showering downwind civilian populations with radioactivity. At the Hanford Reservation in Washington state, technicians intentionally released huge clouds of radioactivity to see what would happen to the human populations thus exposed. In one Hanford experiment 500,000 Curies of radioactive iodine were released; iodine collects in the human thyroid gland. The victims of this experiment, mostly Native Americans, were not told about it for 45 years.[6,pg.96] American sailors on ships and soldiers on the ground were exposed to large doses of radioactivity just to see what would happen to them. The military brass insisted that being showered with radiation is harmless.
In his autobiography, Karl Z. Morgan, who served as radiation safety director at the Oak Ridge National Laboratory (Clinton, Tennessee) from 1944 to 1971, recalls that, "The Veterans Administration seems always on the defensive to make sure the victims are not compensated."[6,pg.10 1] Morgan recounts the story of John D. Smitherman, a Navy man who received large doses of radiation during A-bomb experiments on Bikini Atoll in 1946. Morgan writes, "The Veterans Administration denied any connection to radiation exposure until 1988, when it had awarded his widow benefits. By the time of his death, Smitherman's body was almost consumed by cancers of the lung, bronchial lymph nodes, diaphragm, spleen, pancreas, intestines, stomach, liver, and adrenal glands. In 1989, a year after it had awarded the benefits, the VA revoked them from Smitherman's widow."[6,pg.101]
Starting in the 1940s and continuing into the 1960s, thousands of uranium miners were told that breathing radon gas in the uranium mines of New Mexico was perfectly safe. Only now are the radon-caused lung cancers being tallied up, as the truth leaks out 50 years too late.
In retrospect, a kind of nuclear mania swept the industrial world. What biotechnology and high-tech computers are today, atomic technology was in the 1950s and early 1960s. Government contractors spent billions to develop a nuclear-powered airplane -- even though simple engineering calculations told them early in the project that such a plane would be too heavy to carry a useful cargo.[4,pg.204] Monsanto Research Corporation proposed a plutonium-powered coffee pot that would boil water for 100 years without a refueling.[4,pg.227] A Boston company proposed cufflinks made of radioactive uranium for the simple reason that uranium is heavier than lead and "the unusual weight prevents cuffs from riding up."[4,pg.227]
In 1957, the Atomic Energy Commission established its Plowshare Division -- named of course for the Biblical "swords into plowshares" phrasing in Isaiah (2:4).[4,pg.231] Our government and its industrial partners were determined to show the world that this technology was benign, no matter what the facts might be. On July 14, 1958, Dr. Edward Teller, the father of the H-bomb, arrived in Alaska to announce Project Chariot, a plan to carve a new harbor out of the Alaska coast by detonating up to six H-bombs. After a tremendous political fight -- documented in Dan O'Neill's book, THE FIRECRACKER BOYS -- the plan was shelved. Another plan was developed to blast a new canal across Central America with atomic bombs, simply to give the U.S. some leverage in negotiating with Panama over control of the Panama Canal. That plan, too, was scrapped. In 1967, an A-bomb was detonated underground in New Mexico, to release natural gas trapped in shale rock formations. Trapped gas was in fact released, but -- as the project's engineers should have been able to predict -- the gas turned out to be radioactive so the hole in the ground was plugged and a bronze plaque in the desert is all that remains visible of Project Gasbuggy.[4,pg.236]
In sum, according to NEW YORK TIMES columnist H. Peter Metzger, the Atomic Energy Commission wasted billions of dollars on "crackpot schemes," all for the purpose of proving that nuclear technology is beneficial and not in any way harmful.[4,pg.237]
The Plowshare Division may have been a complete failure, but one lasting result emerged from all these efforts: A powerful culture of denial sunk deep roots into the heart of scientific and industrial America.
[To be continued April 13.]
Descriptor terms: radiation; nuclear weapons; nuclear power; x-rays; cancer; carcinogens; karl z. morgan; downwinders; nevada test site; hanford;
==============  Catherine Caufield, MULTIPLE EXPOSURES; CHRONICLES OF THE RADIATION AGE (New York: Harper & Row, 1989). ISBN  Jim Robbins, "Camping Out in the Merry Widow Mine," HIGH COUNTRY NEWS Vol. 26, No. 12 (June 27, 1994), pgs. unknown. See http://www.hcn.org/1994/jun27/dir/reporters.html. And see http://www.roadsideamerica.com/attract/MTBASradon.html  Arjun Makhijani and Scott Saleska, THE NUCLEAR POWER DECEPTION; U.S. NUCLEAR MYTHOLOGY FROM ELECTRICITY "TOO CHEAP TO METER" TO "INHERENTLY SAFE" REACTORS (New York: The Apex Press, 1999). ISBN 0-945257-75-9.  H. Peter Metzger, THE ATOMIC ESTABLISHMENT (New York: Simon & Schuster, 1972). ISBN 671-21351-2. Michael D'Antonio, ATOMIC HARVEST (New York: Crown Publishers, 1993). ISBN 0-517-58981-8. And: Chip Ward, Canaries on the Rim: Living Downwind in the West (New York: Verso, 1999). ISBN 1859847501.  Karl Z. Morgan and Ken M. Peterson, THE ANGRY GENIE; ONE MAN'S WALK THROUGH THE NUCLEAR AGE (Norman, Oklahoma: University of Oklahoma Press, 1999). ISBN 0-8061-3122-5.  Dan O'Neill, THE FIRECRACKER BOYS (New York: St. Martin's Press, 1994). ISBN 0-312-13416-9.
Some lines from "Your thyroid", by Dr Lawrence Wood et al.:In the 1920's physicians began to use radiation (X rays) to treat non cancerous disorders. One of the more common problems that was treated in this manner was an enlargement of the thymus gland in newborns. The thymus gland is located behind the breastbone and is important for normal immune function.
Other conditions treated in this manner included enlarged tonsils oradenoids, birthmarks, whooping cough, acne, and ringworm of the scalp. Treatment was given by meanss of an X-ray machine ("external beam irradiation") or by placing radioactive material, such as radium, directly in or on the tissue to be treated. For many years radiation was considered good medical therapy for some of these problems. For example deafness was improved when radium treatments shrank enlarged lymph tissue compressing the internal ear canal. Acne could be markedly improved by radiation, resulting in less facial scarring.
In short, radiation therapy was used because it seemed safe andeffective. Unfortunately the thyroid gland, located as it is in front of the neck, often received radiation inadvertently during treatment for these conditions. In the 1950's physicians began to notice an increased number of benign and malign thyroid tumors among patients who had been given radiation therapy years earlier. The fact that the radiation had caused the thyroid tumors was substantiated when it was found that many individuals exposed to atomic-bomb radiation or fallout also developed thyroid tumors in later years. When these facts became known, these forms of radiation therapy were of course discontinued.
Nevertheless it is estimated that two million people in the UnitedStates received radiation treatments in childhod or adolescence between 1920 and the early 1960s. Subsequent large-scale studies of thyroid-cancer frequency in radiated and nonradiated control groups have established beyond doubt the relationship between radiation exposure and thyroid cancer.
Subj: [hyperthyroidism] Re: Back to the Basics -- (Again)
Date: 1/31/00 8:16:19 PM !!!First Boot!!!
From: email@example.com (julia c amado)
I got ophthalmopathy ten months after having RAI. I was not even warned about the possibility!. I did not have ophthalmopathy prior RAI, but developed it some 10 months later, and was clearly induced by it. Although there are endos that don't relate TAO/TED to RAI, most of them accept it does.
The current (1998) edition of Williams' Texbook of Clinical Endocrinologystates that RAI is responsible for the development of TED and pretibial myxedema and exacerbates these conditions when they're already present. Current medical books are now listing ATD's as the treatment of choice. The Williams Text had already demoted RAI from first place, back in 1994, but found occasions where it was the best choice, f.i. for patients allergic to ATDs who are poor surgical candidates, (2nd choice after ATDs) due to advanced age or a coexisting disease making these patients a surgical risk. An article in the New England Journal of Medicine (Jan 8, 1998--Vol. 338, No. 2) that studied the occurrence of TED after RAI showed in its results that 15% of the 150 treated with RAI developed or worsened the TED. The patient's they studied had slight or NO TED before having the RAI. With the group that took the RAI and steroids (145 patients) 50 of the 75 that had TED had improvement and NO patient had progression.
DeGroot et al quote:
It's good another RAI group has been created. The more the best, to get theword out and help people to take as informed decissions as possible. As I've already announced here, yet there is a yahoo club founded on Jan 6th.
Those interested can join it at http://clubs.yahoo.com/clubs/atomicwomen.
More from Julia:
Radioactivity only mutates and lately kills cells, so regretfully
From About.com May 30, 2000:
RADIATION DAMAGE MAY BE PASSED TO OFFSPRING
July 6, 2000
Subj: [hyperthyroidism] Re: WHY?!?! RAI better than surgery?!?!
In May I was diagnosed with HyperT and Graves. 5 Docs(3 endos and 2
From: firstname.lastname@example.org (Horten, Mona)