ENA patient offered radioactive iodine is usually afraid of two things: the word “radioactive”, and being shut in a room for several days. Yet the method is long-established and well studied. The separate room signals no danger to the patient: it is a radiation protection rule that shields other people until the radiation has fallen.
This page covers when radioiodine therapy is used, how patients prepare, how radioiodine therapy in Germany is organised and what follows, which sometimes includes a second course. Other treatments are covered under thyroid treatment in Germany.
How it works and when it is used
Radioactive iodine acts from inside the thyroid and is used mainly when the gland is overactive, nodular or enlarged. The thyroid takes up iodine from the blood to make its hormones, so radioactive iodine collects in its cells and acts on them, while surrounding tissue receives incomparably less. It is swallowed as a capsule, not beamed in from outside.
Indications are an overactive thyroid in Graves’ disease, autonomously functioning nodules, toxic nodular goitre (a gland enlarged by hormone-producing nodules) and an enlarged gland where surgery is undesirable. Separately, radioiodine is a stage of treatment after removal of the gland in certain thyroid cancers, with a different purpose and doses; see thyroid cancer treatment in Germany.
Radioiodine is not chosen, or is postponed, in pregnancy and breastfeeding, when a pregnancy is planned soon, with active eye inflammation in Graves’ disease, and when a large nodule pressing on the airway or gullet must be removed quickly. Surgery is then discussed; see thyroidectomy in Germany.
How patients prepare and how the treatment goes
Preparation means confirmatory tests and temporary changes to medication and diet; the treatment itself takes several days in hospital. Tests cover hormones, ultrasound and scintigraphy with an iodine uptake measurement. Antithyroid drugs are stopped or adjusted on the doctor’s instruction, the diet becomes low in iodine, and iodine-containing contrast media are avoided. After a contrast CT the treatment is usually postponed: the contrast medium is full of ordinary iodine, and the saturated gland takes up less radioactive iodine until the excess is excreted.
In Germany, radioiodine therapy is given only to inpatients, on a special nuclear medicine ward licensed to handle radioactive substances. The patient swallows the capsule, stays in the room for several days under observation and leaves once the measured radiation level has fallen to the permitted value. Outpatient radioiodine therapy, as practised in some countries, is not done here: that is how German radiation protection rules work. The procedure for benign thyroid disease is set out in the German Society of Nuclear Medicine (DGN) guideline on radioiodine therapy.
Tolerance is usually good, though the area over the gland may feel tender or swollen and the mouth dry. Belongings are rarely a problem: what patients bring can usually be taken home again. The hospital explains in advance what to bring, the room rules and the likely length of stay.
What happens after the treatment
Afterwards thyroid function falls, and a substantial proportion of patients become hypothyroid, lacking their own thyroid hormone. This is an expected outcome rather than a complication, treated with a daily hormone tablet under blood test control. That is exactly why an endocrinologist close to home is needed afterwards.
Follow-up includes blood tests at intervals the doctor sets, a repeat ultrasound and an assessment of whether one course was enough. Some patients need a second course: a normal situation, not a failure.
For the first weeks, rules protect other people: less close contact with small children and pregnant women, reliable contraception and postponing pregnancy for the period the doctor specifies, with separate advice for men. The treating doctor gives the actual intervals in writing. The tests are described under thyroid work-up in Germany.
Who gives the treatment, and where
A nuclear medicine physician gives the treatment on a nuclear medicine ward, sharing the indication and later care with an endocrinologist, and with a surgeon and an oncologist where there is a tumour. Examples are Prof. Christoph Rischpler, medical director of the Department of Nuclear Medicine at Klinikum Stuttgart, and Prof. Winfried Brenner, director of the Department of Nuclear Medicine and head of centre CC 6 at the Charité in Berlin.
The hospital needs a department with licensed rooms, so the choice is narrower than for ordinary thyroid treatment; see endocrinology clinics in Germany. A place on such a ward is planned in advance, and the date is set by the hospital.
Frequently asked questions
How many days does the hospital stay last?
Usually several days, but the exact length is not fixed in advance: patients are discharged once the measured radiation has fallen to the permitted value, and a large gland can mean a longer stay. The hospital gives an estimate before the trip, but the discharge day only becomes clear during treatment, so a rebookable return ticket helps.
Is the patient a risk to family members after discharge?
The risk is low if the discharge rules are followed. Patients leave the ward only once the radiation has fallen to a level acceptable for others. A small amount remains for a while, so for the first weeks patients keep away from small children and pregnant women and limit long close contact, for as long as the doctor specifies in writing.
Can I have children after radioiodine therapy?
Yes, but not straight away: pregnancy is postponed for a period the doctor specifies, with reliable contraception throughout. Men receive separate advice on when to father a child. If a pregnancy is planned soon, tell the doctor before the treatment, because surgery or another route may then be suggested.
How AlenMed arranges the treatment
AlenMed starts with the documents: hormone results, ultrasound reports, scintigraphy findings and discharge summaries go to a nuclear medicine department. The company works with 86 partner hospitals in 38 German cities and 345 doctors, and its office is in Munich. The translated discharge summary is followed by the hospital’s written reply, the invitation letter, the medical visa and an interpreter. Unusually, the dates depend on a free room, so the visa and flights are planned around a confirmed date.
Ask in advance how many days on the ward are planned, what may not be taken into the room, who will monitor the hormones back home and at what intervals, what to do at the first signs of an underactive thyroid, and which documents to take home.
This material is for information only and is not an offer; the treatment plan is decided by a doctor in person.
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