Dr. Jaydeep Tripathy
General Practitioner
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had a thyroid uptake scan done about a week ago. I was given radioactive iodine 123 (orange and blue pill) 273 uci for the test. I had an odd reaction to the iodine pill that I believe to be either the Wolff-Chaikoff effect or the Jod Basedow effect. So, How much iodine was in the pill, I took?
Hello,
Welcome to icliniq.com.
I understand your concern.
Radioactive Iodine I-123 or I-131 is given mostly to hyperthyroid patients for diagnostic and therapeutic purposes. Mostly it leads to recovery from hyperthyroidism within 12 hours of the treatment. The dosage depends entirely on your triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormones (TSH) values. So if you can put up your pre-testing values, I can guide you further. However, the strange reaction you are describing does not last long. Wolff-Chaikoff is a beneficial phenomenon in which a person's thyroid values are suppressed following hyperthyroidism treatment. People with normal thyroids generally do not exhibit this phenomenon. However, it can last up to two weeks before the thyroid values return to normal.
I believe you experienced the Jod-Basedow phenomenon in your case. This complication can occur in multinodular goiter patients on rare occasions, where iodine ingested for therapeutic purposes causes a paradoxical increase in serum thyroid levels. So, if you take thyroid medication, you should be extra cautious. Talk to your doctor about how to lower your levels if you are experiencing hyperthyroid symptoms like increased appetite with weight loss, severe heat intolerance, or palpitations.
Patient's Query
Hi doctor,
Thank you for the reply.
My levels were the following for the pre-test:
TSH - 0.835 uIU/mL (Range 0.5 - 4.70 µIU/mL)
Total T3 - 1.5 ng/mL (Range: 0.6 - 1.6 ng/mL)
Total T4 - 11.0 ug/dL (Range 4.5 - 11.5 ug/dL)
T4 Free - 1.15 ng/dL (Range 0.76 - 1.46ng/dL)
The tests I had were radioactive iodine uptake and thyroid imaging. They gave me radioactive iodine 123 pills, according to the sheet they gave me. However, it did not say how much iodine was in it. The pill was orange and white in color. My reaction was overwhelmingly positive. For the past 27 years, I have not felt well at all. My most severe symptom is severe brain fog. I felt great about 4 hours after taking that iodine pill. As if everything was normal. All of my negative physical sensations had vanished, including the brain fog. It was a great day.
When I told my doctor about it, she got angry and said she had never heard anything like it. So anyway, for the next two days following the test, I felt as if I had been thrown into a pit of despair. It was dreadful. I was so tired and depressed that I was crying. Then by the third day, I felt like my usual yucky feeling, so I am not sure if my levels went up that day and then dropped off for the next two days or if my levels went down slightly initially and way down the following two days. However, according to the scan, everything appears to be normal. There is no goiter or nodules, and the size is normal. My mother had Graves disease, which required the removal of her thyroid. Any insight you can provide would be greatly appreciated.
Hello,
Welcome back to icliniq.com.
I understand your concern.
I agree that not everything has to happen theoretically. For example, we learn in school that malaria patients undergo three distinct phases: the hot, the sweating, and the cold. I have never seen anything like it. I am trying to explain that I understand that you felt a lot better after the pill. So now let us analyze your situation. First and foremost, if possible, please provide me with an entire history the next time we meet. Second, I would like to look at your symptoms to see if you have any other signs of hypo or hyperthyroidism and brain fog. Hypothyroidism is characterized by fatigue, cold intolerance, delayed periods, constipation, and other symptoms. Excessive weight loss, increased bowel movements, menorrhagia, mood swings between depression and agitation, heat intolerance, and increased appetite are all symptoms of hyperthyroidism. I am listing the causes so you can see if the other symptoms match yours and assist me further with your situation. I checked your pre-test results, and it surprised me that the radioactive iodine uptake scan was still performed on you. Your reports show that everything is fine. All values are within a normal range, indicating a euthyroid state. Some patients may have nodules, indicating previous episodes of hypothyroidism but not currently toxic.
We do not recommend performing this test in euthyroid individuals because there is always the possibility that after exogenous iodide administration, thyroid values will be completely suppressed for some time. As a result, it is used to treat hyperthyroidism. Some people experience the Jod-Basedow phenomenon, which causes hyperthyroidism after ingesting iodide because radioactive iodine can cause a loss of thyroid-stimulating hormones (TSH) control and thus extra thyroid levels in the bloodstream. In your case, brain fog could be a sign of hypothyroidism. It can occur due to the gland's abnormal functioning or insufficient pituitary TSH secretion. As a result, I will need you to list any other symptoms you may be experiencing. I recommend you wait a week and have only the triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormones (TSH) values rechecked. Make sure you give the blood early in the morning and that you are fasting. If you give your blood later in the day, thyroid values may fluctuate, and we will not get an accurate picture. Your analysis is correct, and I agree with you. When you took the pill, I believe you experienced the Jod-Basedow phenomenon, in which the thyroid values briefly increased, allowing you to recover from your brain fog and hypothyroid symptoms. All of your symptoms returned once you were no longer taking the pill, and your thyroid returned to a hypothyroid state. Please respond with more information about your other symptoms and whether you have received any levothyroxine treatment. Also, your previous thyroid profile test results, whether you have been pregnant, how the child is doing, your current weight, and any other medical problems.
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General Practitioner
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