Hello, Ellen (and everyone),
I write as a thyroid cancer patient/survivor who was (and still is)
breastfeeding at the time of thyroid cancer diagnosis and follow-up
(which is life-long). I would like to add a couple of points to what
has already been mentioned.
The I-131 is used for ablation, meaning eliminating (ideally) all
remaining thyroid cells after the thyroidectomy. I believe it is
recommended that one not become pregnant or breastfeed for at least 1
year following I-131 treatment. Not everyone who has a thyroid cancer
diagnosis has the ablation, although it seems to be rare not to. Often
a scan is also done both at the time of ablation and also as routine
follow-up. It is often a different isotope (I-123? 121? I don't have my
notes with me at the moment, sorry) used for the scan, the affect of
which is different for breastfeeding. I was supposed to have a scan
when breastfeeding, but after a great deal of research (and finally
finding a post-doc in a nuclear medicine lab who knew something about
this), it was determined that although the half-life of the other
isotope theoretically means the mom can "pump and dump" for awhile (I
don't remember how long) instead of weaning completely, it was
determined that there is no guarantee that the I-123 (again, I'm not
positive that's the isotope) is not completely free of I-131, and in
fact there seemed to be a pretty good chance that there would be some
I-131 contamination. I-131 can destroy the baby's thyroid. This person
spoke with the actual manufacturer of the radioactive iodine; she told
me if it were her she would not go through the scan while breastfeeding,
regardless of the isotope. It was therefore recommended that this scan
not be done on a breastfeeding mom. I'm sure there are folks out there
more knowledgeable about this than I, but I wanted to point out that
even if it is not I-131 check it out *thoroughly*.
There is a phenomenal on-line support group for thyroid cancer patients
at: http://health.groups.yahoo.com/group/Thyca/, which I would highly
recommend. I've been able to connect there with other breastfeeding
moms who have gotten a thyroid cancer diagnosis. There are new
guidelines on the treatment of thyroid cancer, which can be found on
this web site as well.
Also, there is a period of *complete* isolation after I-131 ablation.
It depends where the patient lives as to what the hospital regulations
are - some require in-hospital isolation for several days, some don't,
some take into account the patient's living situation. She would
probably not be able to be around anyone at all for 3-4 days, followed
by a week or two of having to keep an across-the-room distance from
other people, and it would be even more for a baby.
There is some research that indicates a connection between thyroid
cancer and breast cancer, although the jury is still out on this. Some
believe that because lactating tissue takes up the radiation more than
other tissue, the radioactive iodine may affect the breast tissue of a
mom who has recently been breastfeeding even more significantly. As I
said, there is not agreement on this, but here is an interesting article
that is related:
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Thyroid_Cancer_and_Br
east_Cancer_Linked_in_Women.asp
One other thing someone mentioned that is not completely accurate
("Replacement therapy should be equal to normal hormone levels"). The
thyroid hormone levels post-thyroid cancer are not exactly the same as a
"normal" (non thyroid cancer) person. Usually thyroid cancer patients
are made to have a suppressed TSH and are slightly on the hyperthyroid
side, as it keeps the chance of recurrence down.
As I mentioned, I have gone through all this, too. In fact, I was able
to work with my endocrinologist (that is who should be following her
thyroid cancer), to put off I-131 ablation indefinitely, but this isn't
right for everyone - it would depend on lots of factors, including tumor
size, affected lymph nodes, metastasis, etc. I would be happy to talk
with this mom as a fellow thyroid cancer patient, if that would be
helpful.
Best wishes,
Stacey Thebodo
[log in to unmask]
------------------------------
Date: Mon, 20 Feb 2006 23:06:32 -0800
From: Ellen Steinberg <[log in to unmask]>
Subject: Iodine 131
Thank you to Pat, Ann and Cheryl for responding so quickly to my
patient's
needs.
An update on her condition - she finally feels like her breasts are full
and
her baby this afternoon appeared "milk drunk".
From all of your advice, as well as Hale's recommendations, I plan to
recommend the following:
1. She should definitely start out by breastfeeding. I will help her to
attain a deeper latch to avoid her sore nipple problem.
2. I will recommend she include pumping in her routine so that she can
begin
to stockpile her milk in preparation for the iodine treatment.
3. I will recommend that she speak to her physician about putting off
the
procedure for as long as is medically safe and about the possibility of
using an agent other than
I-131 that may be less hazardous.
4. I will recommend that she weans approximately 3-4 weeks before she
has to
have the iodine treatment. She needs adequate time for her breasts to
involute. I will suggest that she speak with her OB about using
medication
to help her involute faster.
5. She and I have already discussed that it may be necessary for her to
not
have close contact with her baby for a period of time after the iodine
treatment.
6. Mom and I also have come to the conclusion that it would be
unadvisable
for her to re-lactate after the treatment.
============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Tarzana, CA
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