A bottle of multiple doses of radioactive iodine with a pill containing one dose. Radioactive iodine is used to treat thyroid cancers and diseases.

Utah mom reflects on cancer treatment with radioactive iodine, which has stood the test of time

A multi-dose bottle of radioactive iodine with a pill containing one dose. Radioactive iodine is used to treat cancers and thyroid disease. (Utah Health University)

Estimated reading time: 6-7 minutes

SALT LAKE CITY — Shirley Crepeaux was a little hesitant when doctors suggested radioactive iodine as a treatment for her thyroid cancer about 12 years ago. She trusted her doctors at the Huntsman Cancer Institute, but she was still terrified and scared.

“If I have to leave a 12-year-old alone and my widowed husband or drink poison, I will drink poison,” she said.

Crépeaux, now 54, is a mother of four children. When she was diagnosed with cancer, her youngest was 12 years old.

“We tried to make the cancer diagnosis as big a non-event as possible,” she said.

The radioactive iodine treatment, however, was definitely an event.

She was given a small vial to drink while alone in a specific room and received numerous warnings over a loudspeaker system telling her not to knock it over or drop it. She said it tasted salty.

After drinking it, she was told to stay away from pregnant women and children for a week. She spent a week in her room. Crepeaux said it was “pretty miserable”, but her husband did what he could to help her stay in touch with the family, including video calls at the breakfast table and signs at through the window.

“In the grand scheme of things, it was a week of my life and then I was back to being myself,” she said.

How it works

Thyroid cancer is one of the most common cancers and one of the easiest to treat, in part because of radioactive iodine.

Dr Dev Abraham of the Huntsman Cancer Institute said radioactive iodine was first used in the 1930s and 1940s, around the same time chemotherapy was being developed, and the treatment became popular in the 1960s. It treats thyroid cancers and disorders and Graves’ disease, which causes the thyroid to overproduce hormones.

“He’s stood the test of time,” Abraham said.

What has changed throughout its use is the dosage, Abraham said there have been more reports recently showing a small but statistically significant increase showing that too much radioactive iodine can lead to a higher risk of other cancers, leading to a reduction in dosages in the last five to 10 years.

Radioactive iodine is used to treat cancers and thyroid disorders.  As it is a radioactive substance, many precautions are taken to reduce exposure.
Radioactive iodine is used to treat cancers and thyroid disorders. As it is a radioactive substance, many precautions are taken to reduce exposure. (Photo: University of Utah Health)

Radioactive iodine is given in a capsule or drink, and Abraham said it’s a unique targeted treatment. Thyroid tissue, including tissue from thyroid cancer that has spread throughout the body, will be destroyed by the treatment once it enters the cell. Other cells that come into contact with radioactive iodine in the blood will not be affected.

“It is a treatment that is specifically determined by the ability of the tissue to absorb, uptake or scavenge iodine. Thus, iodine scavenging tissues are particularly susceptible to being killed by this low level radioactivity,” said Abraham.

Before taking a dose of radioactive iodine, doctors like Abraham will help a patient starve their thyroid and cancerous tissues of iodine by avoiding certain foods to make those cells feel hungry and absorb more radioactive iodine.

Most often the treatment is used after a large part of the cancer has been surgically removed to treat remnants of thyroid tissue that may contain cancer cells or cancer cells that have spread, which is more common in cancers thyroid than in many other cancers.

He said that in many cancers, spread to other areas results in a worse prognosis. But with radioactive iodine, the spread of thyroid cancer doesn’t necessarily mean a worse prognosis.

Long term effects

Abraham said that although one death is too many, not many patients die from thyroid cancer. The American Cancer Society estimates that there were about 43,800 new cases of thyroid cancer in 2022 and about 2,230 deaths.

The main goal of radioactive iodine is to reduce the frequency of recurrence of thyroid cancer, he said.

Crepeaux continues to have appointments with Abraham every year, he said he has taken care of her for years and it looks like she will continue to do very well and that the treatment at the radioactive iodine was effective.

Crepeaux is one of the few thyroid cancer patients to have residual disease, small amounts of cancer that don’t grow. Abraham said these were probably dying thyroid cancer cells, and in most patients the remaining but not progressing cancer cells were as effective as a cure.

Due to the radioactive iodine treatment, Crepeaux constantly struggles with a dry nose, throat and eyes. She said she always had her water bottle with her and used products to help add moisture.

Abraham said that’s one of the reasons treatment needs to be tailored to the patient, using the smallest effective dose. He said two doses are sometimes used in severe cases, but rarely three.

If the cancer came back and Crepeaux decided to have a second dose of radioactive iodine, she said it would stop her from crying, spitting up or saliva – even more discomfort.

Optimism

Crepeaux was a hairdresser for 30 years, but now she’s in school to become a medical assistant.

“It’s something that happened to me. It’s not who I am. I’m Shirley and I’ll always be Shirley. A little salty. A little steamy. … I’m not kidding anyone. What if I t love , I love you with everything…I won’t let cancer or anything else change that or define me,” she said.

She said it was thanks to her GP that she got screened for thyroid cancer. If she hadn’t, she could have died within a few years. When it was found it was between stages three and four and had already spread to his lungs. Her only symptom so far was shoulder pain and difficulty swallowing.

Now, Crepeaux encourages everyone to check for thyroid lumps by doing self-checks, or ask their doctor for a check-up during an annual physical.

Crepeaux was told after her operation that she would have a very whispery and raspy voice, but therapy and her strong voice helped save her voice – although she said it now takes a lot more effort to produce an audible voice.

“Fortunately, I was one of those people with an extremely loud voice before the operation, so now I just have a normal voice,” she said.

His laugh, however, is still the same loud laugh, a laugh that makes the others in the room laugh even more.

Overall, Crepeaux shared a message that there is hope and encouraged others going through similar situations to be grateful and focus on the little things that bring them happiness.

“Most people with cancer live with it, they don’t die with it,” she said.

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Emily Ashcraft joined KSL.com as a reporter in 2021. She covers court and legal affairs, as well as health, faith and religion news.

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