RAI Increased Chances of Breast Cancer

[unsure613]

My Dr. is suggesting RAI treatment or surgery (up to me)  for a mild case of hyperthyroidism. I have one larger nodule and have been on PTU for about a year, but as soon as I came off my levels went back. The sizes of the nodules are the same from my ultrasounds. Most posts suggest RAI, but I have also read that more recently they have found a 20% increased risk for breast and ovarium cancer.  My mother died from breast cancer so my risk is higher to begin with and there is other cancer in the family, i.e. pancreatis and prostate. I am 43, white and pre-menopausal (occassional hot flashes, only symptom), which I read this is who has the greater risk with RAI. Neither option sounds great for other reasons too, but this is the risk that worries me the most (although the fact that no one should be around you for long periods after taking RAI, makes you kind of wonder, if it's risky for other people, then why is it safe to be inside me).  Are there any other options and what do you know about Minimally Invasive Surgery?

[unsure613]

Thank you for responding and for your valuable input. This post has been a world of information for me, and I'm sure for many others as well. I think it's a wonderful thing that you take the time to answer and do this for all of us.

I've been reading more about the minimal invasive surgury and will talk to my Dr.to see if he can recommend a surgeon for me to at least speak with here in South FL.

By the way, here were my results from my the ultrasound in December.......

Subclinical hyperthyroidism and multi-nodular goiter.

Ultrasound- On the right at upper pole, there is a solid nodule measuring 0.8 cm in size and a complex cyst measuring 0.8 cm in size. In the mid pole, there is a solid module measuring 1.1 cm in size. At the lower pole there is a cyst measuring 0.7 cm in size.  On the left in the mid pole, there  is a complex module measuring 0.9 cm in size and at the lower pole, there is a solid nodule measuring measuring 3.1 cm in size. thyroid antibodies were negative.

Uptake: enlarged gland w/ multi-nodular appearance and hyperfunctioning hot nodule at the left lower pole on left. The 24-hour uptake level is 36% which is elevated.

Blood - TSH is the only result that comes out low.... 0.229 this last test

TY again.

[Mark Lupo, M.D.]

I presume the large nodule is over-functioning and is the cause of the hyperthyroidism (ie, toxic nodule).  Options are RAI vs surgery.  The risk of inducing a cancer with RAI is very low for the doses we use for a hot nodule (20-30mCi).  This would be the standard approach.  However, in expert hands (this is the key), thyroid surgery is a very good option.  A thorough neck ultrasound to ensure there are not other nodules are abnormalities is recommended to decide on the extent of surgery, but usually the side of the thyroid the hot nodule is on is removed.  Some surgeons selectively remove the hot nodule only - but the standard surgery is removing the entire lobe.