Experiences with a low-iodine diet: A qualitative study of patients with thyroid cancer receiving radioactive iodine therapy

Low-iodine diet: what to eat and avoid before iodine-131 procedures?

OBJECTIVE

The aim of this study was to compile a list of low-iodine foods for use in the Low-Iodine Diet (LID) to optimize the uptake of Iodine-131 by cells, which is used in the diagnosis and treatment of thyroid gland disorders.

METHODS

A bibliographic research was conducted focusing on the most commonly consumed foods in Brazil. Iodine quantification was derived from both national and international food composition tables, with an emphasis on sources indicating the highest concentrations of this microelement. The foods were organized into categories, and their iodine levels were presented in micrograms per 100 grams of food.

RESULTS

The compiled list includes foods classified into categories such as cereals, legumes, vegetables, fruits, flours, oils, fats, meats, dairy products, and beverages. Foods with more than 50 μg of iodine per 100 g were identified and classified separately. Based on the findings, marine-derived foods should be avoided, while dairy products and eggs can be consumed, provided substitutions are made.

CONCLUSION

Identifying and quantifying low-iodine foods is essential for guiding the LID, making it more effective and better suited to the population's needs. Legumes, vegetables, and most fruits can be consumed in larger quantities, forming the core of the diet.

Perception of health and illness and quality of life after total thyroidectomy for differentiated thyroid carcinoma: the PERSAM study

Background

Differentiated thyroid carcinoma is the most common endocrine neoplasm; several studies have shown that individuals perceive the disease as being more severe than it actually is, resulting in a reduced quality of life. The primary aim of this study is to assess the quality of life and perception of illness among patients admitted for radiometabolic therapy, post total thyroidectomy for differentiated thyroid carcinoma. The secondary aim is to identify which patient characteristics are associated with a lower quality of life in order to improve and personalize care.

Methods

The study was conducted at the UOC of Radiotherapy Veneto Institute of Oncology IOV-IRCCS in Padua, Italy. Three questionnaires were administered: Psychological General Well-Being Index (PGWBI), the Illness Perception Questionnaire (IPQ-R) and the Short Form Survey (SF-12). A descriptive statistics analysis and multiple linear regression models were performed to explore the relationship between some of the variables.

Results

Significant associations emerged between the type of surgery and higher values on the PGWBI questionnaire (P = 0.022) and the score obtained in the 'emotional representations' dimension of the IPQ-R questionnaire (P = 0.028). Pathology staging was statistically significantly (P = 0.026) associated with the score obtained in the dimension 'identity'; age with the scores obtained in the dimensions 'emotional representations' (P = 0.035), 'personal control' (P = 0.004), 'consistency with pathology' (P < 0.001) and 'causes' (P = 0.004).

Conclusions

There is evidence of moderate distress in psychological well-being and good perception of pathology. There is less understanding of the disease in individuals with stage 3 and 4 thyroid cancer, in those who have undergone total thyroidectomy without lymphadenectomy and who are aged over 60. Physical well-being: limitations in self-care and moderately physically demanding activities. Mental health: more information to patients decreases the degree of stress and promotes 'positive' emotions. Physical health status: a long-term activity program, characterized by aerobic exercises to be performed in groups or at home, is useful. This study allows to transpose the results into clinical practice, evaluating the possibility and methods of providing personalized care to patients.

Reducing anxiety and enhancing satisfaction in thyroid patients with DietLens application during radioactive iodine therapy: A quasi-experimental study

Hyperthyroidism and thyroid cancer significantly impact health, and often require Radioactive Iodine (RAI) therapy. Anxiety is common in patients undergoing RAI, particularly related to dietary compliance. This study aimed to assess the effectiveness of the mobile health application, DietLens in reducing anxiety and increasing satisfaction in patients preparing for RAI therapy, focusing on low-iodine diet (LID). A quasi-experimental study was conducted in a Singapore tertiary hospital outpatient department from March 13, 2019 to March 27, 2020, involving patients scheduled for their first RAI treatment. Participants were divided into a control group receiving standard care and an intervention group using DietLens alongside standard care. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale, and satisfaction levels were measured through self-reported questionnaires. In the study, 56 participants were initially divided into control (n = 28) and intervention (n = 28) groups. After accounting for dropouts, 50 participants finished the study, with each group comprising 25 individuals. Anxiety levels were similar between groups pre-intervention. Post-intervention, the intervention group displayed a significant decrease in anxiety levels compared to the control group (independent t-test: t (48) = 2.50, p = 0.02). The multivariate linear regression analysis indicated that being in the intervention group was significantly associated with a decrease in post-intervention anxiety score (β = -4.03, 95 % CI: -7.33 to -0.72, p = 0.02). Fisher's Exact Test revealed a borderline significant difference in satisfaction with educational materials and the overall treatment process, with 100 % of the intervention group expressing satisfaction compared to 80 % in the control group, resulting in a p-value of 0.052 in both instances. DietLens was effective in reducing anxiety and enhancing satisfaction related to RAI therapy preparation, particularly in managing a LID, highlighting a beneficial role for digital interventions in healthcare settings.

Distress, illness perception and coping style among thyroid cancer patients after thyroidectomy: A cross-sectional study

PURPOSE

Thyroid cancer generally has a good prognosis, and thyroidectomy is the main treatment given to thyroid cancer patients. Almost every cancer patient experiences varying degrees of distress, which can reduce their quality of life. This study aims to explore the level of distress and its relationship with illness perception and coping style among Chinese thyroid cancer patients after thyroidectomy and to identify the influencing factors on distress.

METHODS

A cross-sectional study with convenience sampling method was conducted. Totally 184 thyroid cancer patients after thyroidectomy were recruited in a tertiary hospital in Southern China with the response rate being 94.4% . The participants were investigated by a self-designed demographic and disease-related questionnaire, the Distress Management, the Brief Illness Perception Questionnaire, and the Medical Coping Modes Questionnaire. Descriptive statistics, univariate analysis, and multivariate linear regression were applied for data analysis.

RESULTS

In total, 99 (53.8%) thyroid cancer patients after thyroidectomy scored 4 or higher on the DT. Illness perception, emotional problem, body image loss by surgical scars, and acceptance-resignation were the influencing factors of distress and could explain 67.6% of the variance of distress among thyroid cancer patients after thyroidectomy.

CONCLUSIONS

Healthcare professionals should not ignore the distress among thyroid cancer patients after thyroidectomy and should take effective measures to alleviate the distress of thyroid cancer patients after thyroidectomy by enhancing their accurate and positive illness perceptions, decreasing their emotional problems, alleviating their body image loss by surgical scars, and avoiding acceptance-resignation coping style.

Impact of low iodine diets on ablation success in differentiated thyroid cancer: A mixed-methods systematic review and meta-analysis

BACKGROUND

Debate remains regarding whether to recommend a low iodine diet (LID) before radioactive-iodine treatment and its duration and stringency. This mixed-methods review aimed to determine if iodine status affects treatment success, the most effective diet to reduce iodine status, and how LID impacts wellbeing.

METHODS

Five electronic databases were searched until February 2021. An effectiveness synthesis (quantitative studies) and views synthesis (qualitative, survey, and experience-based evidence) were conducted individually and then integrated. Quality assessment was undertaken.

RESULTS

Fifty-six quantitative and three qualitative studies were identified. There was greater ablation success for those with an iodine status of &lt;50 mcg/L (or mcg/gCr) compared with ≥250 (odds ratio [OR] = 2.63, 95% confidence interval [CI], 1.18-5.86, n = 283, GRADE certainty of evidence very low). One study compared &lt;50 mcg/L (or mcg/gCr) to 100-199 and showed similar rates of ablation success (OR = 1.59, 95% CI, 0.48-6.15, n = 113; moderate risk of bias). People following a stricter LID before ablation had similar rates of success to a less-strict diet (OR = 0.67, 95% CI, 0.26-1.73, n = 256, GRADE certainty of evidence very low). A stricter LID reduced iodine status more than a less strict (SMD = -0.40, 95% CI, -0.56 to -0.24, n = 816), and reduction was seen after 1 and 2 weeks. The main challenges were a negative impact on psychological health, over restriction, confusion, and difficulty for sub-groups.

CONCLUSIONS

Although a LID of 1-2 weeks reduces iodine status, it remains unclear whether iodine status affects treatment success as only a few low-quality studies have examined this. LIDs are challenging for patients. Higher-quality studies are needed to confirm whether a LID is necessary.

Anxiety and depression status prior to radioactive iodine therapy among differentiated thyroid cancer patients during the COVID‑19 pandemic

Objection

The psychological health of thyroid cancer patients cannot be ignored; however, few studies have been conducted on the psychological status and influencing factors of thyroid cancer patients before radioactive iodine (RAI) therapy. The aim of this study was to investigate the incidence and risk factors for anxiety and depression in thyroid cancer patients prior to RAI therapy.

Methods

Clinical data were collected from patients with differentiated thyroid cancer (DTC) patients preparing for RAI therapy. Anxiety and depression were measured before RAI therapy using the Generalized Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-9). We used the chi-square test and logistic regression analysis to identify independent risk factors for anxiety and depression.

Results

A total of 112 patients with thyroid cancer were included. Of these, 72.32% (n = 81) were female, with a mean age of 41.50 years. Anxiety and depression were reported by 46 (41.08%) and 38 (33.93%) patients, respectively. Based on the chi-square test and univariate logistic regression analysis, being female and having ever-experienced RAI therapy were significant risk factors for anxiety and depression among DTCs prior to RAI therapy. On multivariable analysis, the results of model 2 which included age, sex, education level, and ever suffering radioactive iodine therapy showed that being female was markedly associated with anxiety and depression in these patients, while having ever undergone RAI therapy was significantly related to anxiety but not depression.

Conclusions

The incidence of anxiety and depression among patients with DTC prior to RAI therapy were 41.08% and 33.93%, respectively. Being female and having ever experienced RAI therapy significantly influenced anxiety and depression. Based on these findings, anxiety and depression assessment should be an important part of pre-RAI therapy in patients with DTC, and appropriate psychological nursing intervention can be carried out for key patients.

Supplementary information

The online version contains supplementary material available at 10.1007/s00520-022-07422-7.

Low-Iodine Diet of 4 Days Is Sufficient Preparation for 131I Therapy in Differentiated Thyroid Cancer Patients

CONTEXT

No consensus exists about the optimal duration of the low-iodine diet (LID) in the preparation of 131I therapy in differentiated thyroid cancer (DTC) patients.

OBJECTIVE

This work aimed to investigate if a LID of 4 days is enough to achieve adequate iodine depletion in preparation for 131I therapy. In addition, the nutritional status of the LID was evaluated.

METHODS

In this prospective study, 65 DTC patients treated at 2 university medical centers were included between 2018 and 2021. The patients collected 24-hour urine on days 4 and 7 of the LID and kept a food diary before and during the LID. The primary outcome was the difference between the 24-hour urinary iodine excretion (UIE) on both days.

RESULTS

The median 24-hour UIE on days 4 and 7 of the LID were not significantly different (36.1 mcg [interquartile range, 25.4-51.2 mcg] and 36.5 mcg [interquartile range, 23.9-47.7 mcg], respectively, P = .43). On day 4 of the LID, 72.1% of the DTC patients were adequately prepared (24-hour UIE < 50 mcg), and 82.0% of the DTC patients on day 7 (P = .18). Compared to the self-reported regular diet, DTC patients showed a significantly (P < .01) lower percentage of nutrient intake (calories, protein, calcium, iodine, and water) during the LID.

CONCLUSION

The 24-hour UIE on day 4 of the LID did not differ from day 7, and therefore shortening the LID from 7 to 4 days seems justified to prepare DTC patients for 131I therapy in areas with sufficient iodine intake and may be beneficial to maintain a sufficient nutritional intake during DTC treatment.

Experiences of Korean patients with Thyroid Cancer Receiving Radioactive Iodine Therapy after Total Thyroidectomy

Objective

South Korea has a high incidence of thyroid cancer. This study aimed to describe and understand the nature of the experience of Korean patients with thyroid cancer undergoing radioactive iodine treatment after total thyroidectomy through an in-depth investigation of their experience.

Methods

Individual interviews using open questions were conducted with 22 participants living in South Korea. All were audio-recorded and transcribed verbatim. This study used the phenomenological analysis method proposed by Colaizzi to determine the essential subjects verified according to the four reliability criteria proposed by Guba and Lincoln.

Results

Three categories, 6 theme clusters, and 13 themes emerged from the study. The three categories identified were “broken life,” “solitude in a crowd,” and “positive changes in values.” The six theme clusters were “anxiety about death,” “an imperfect being,” “feeling social isolation,” “struggling alone,” “an active attitude toward life,” and “life support.” The themes that emerged the most were related to physical and psychological difficulties. Of the 13 themes, four themes were related to family-oriented values and culture.

Conclusions

This study suggests that nursing interventions are required to reduce the physical and psychological symptoms of Korean patients with thyroid cancer. It is necessary to build a support system with the patient's family members to consider family-oriented values and culture.

Experiences of low iodine diets in the treatment of differentiated thyroid cancer with radioactive iodine ablation therapy

BACKGROUND AND AIMS

International guidelines on the treatment of differentiated thyroid cancers (DTC) promote the use of low iodine diets (LID) prior to radioactive iodine remnant ablation (RIA), as high iodine status may interfere with radioiodine uptake. Most UK treatment centres adhere to these guidelines and advise people to consume a LID. There is limited research as to how people cope with the LID or its impact on daily life and wellbeing, and no studies have been conducted in the UK. This study explored peoples' views and experiences in relation to consuming a LID during treatment for DTC with RIA.

METHODS

Twenty-eight semi-structured interviews were conducted with people from across three treatment centres where differing advice had been delivered regarding a LID. Interviews were recorded, transcribed verbatim and key themes were developed through inductive thematic analyses.

RESULTS

Individuals advised to consume a LID believed that adhering to the diet would help their treatment. Most restricted their diets beyond what was recommended and there was confusion surrounding what they could eat as part of the diet. Food selection and preparation were important which included substitution of foods and ingredient checking. Being on the diet was considered to have both a physical and psychological impact.

CONCLUSIONS

The findings of this study provide a qualitative insight into the lived experiences of people with DTC in relation to consuming a LID. The results have relevance for professionals providing dietary guidance at oncology centres treating patients with RIA therapy in the UK.

A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer

BACKGROUND

Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice.

METHODS

We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer ¹³¹I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed.

RESULTS

Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when ¹³¹I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24-48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice.

CONCLUSIONS

UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.

Side effect experiences of South Korean women in their twenties and thirties after facial plastic surgery

Background

Rates of plastic surgery procedures have increased dramatically over the past several decades, especially for the women in South Korea.

Purpose

The purpose of this study was to explore the subjective experience of South Korean women in their twenties and thirties with facial plastic surgery (FPS) side effects.

Participants and methods

Seven women who have suffered from FPS side effects participated in this study. Data were collected from July to September 2015 through individual in-depth interviews using open-ended questions and analyzed using Colaizzi’s method, which is a Husserlian phenomenological approach.

Results

Six themes, and 25 subthemes, were found. Major themes were “choosing FPS to gain a new self”, “facing an unintended self”, “trying to accept a changed self”, “making efforts to overcome the situation”, “coming to know a new world”, and “pursuing a new lifestyle”.

Conclusion

This study raises social awareness on the risk of plastic surgery side effects, which could prevent unnecessary plastic surgery. It also suggests the need for a deeper understanding of women’s biopsychosocial suffering from plastic surgery side effects.

Analysis of Iodine Content in Salts and Korean Sauces for Low-Iodine Diet Education in Korean Patients with Thyroid Cancer Preparing for Radioiodine Therapy

PURPOSE

A low-iodine diet is necessary in patients about to undergo radioiodine therapy for thyroid cancer to decrease the competitive absorption of ingested nonradioactive iodine. This study aimed to assess the iodine concentrations in salts and basic Korean sauces, and to provide fundamental data for guidelines on a low-iodine diet before radioiodine therapy.

METHODS

The iodine contents of refined salts, solar sea salts, fish sauces, and commonly used Korean sauces with added refined salt were determined by ICP-MS.

RESULTS

The iodine content of refined salts was found to be very low (0.033 ± 0.05 μg/100 g) compared with that of solar sea salts (434 ± 73.6 μg/100 g). The iodine contents of Korean soy sauce, Korean soybean paste, Gochujang seasoned with refined salt were also very low (0.010, 0.044, 0.002 μg/100 g, respectively). However, the mean iodine contents of the shrimp and fish Jeots analyzed in this study were found to be 41.3 ± 4.2 and 24.8 ± 4.5 μg/100 g, respectively.

CONCLUSION

This study is the first to investigate the iodine contents of the salts and basic sauces used in Korea. The results show that refined salts and Korean traditional sauces seasoned with them can be safely used in low-iodine diets before radioiodine therapy.