TIME TO TREATMENT: Stable patients who have completed a methimazole or y/d trial: usually 1-2 months. Patients who do not tolerate those treatments: usually within a month.
COST: Consult $170-$200. Pre-testing (not all tests are required for each patient): ~$300-~$1100. Radioiodine: $1475 - 48 hour stay, usually for patients with TT4 less than 10. $1575 - 72 hour stay, usually for patients with TT4 up to 20. $1875 - 72 hr stay, higher dose for aggressive benign nodules. $3000 - 10 day stay, high dose for suspected adenocarcinoma. Post-testing: per your fees.
Most patients should have completed a methimazole or y/d trial prior to referral. Younger patients with TT4 < ~ 7.5, mild clinical signs, and no evidence of renal disease may be exceptions.
Other than rare exceptions, we will advise waiting to do radioiodine for gray zone TT4 cases due to the higher risk of iatrogenic hypothyroidism. Gray zone discussion
Radioiodine is most effective when pursued early in the disease. Clients are advised of a lower 1st injection cure rate with longer disease course and higher TT4 (85 – 90% vs 95% for early cases).
Patients must be stable to be admitted to the hospital for the injection and post-radioiodine isolation. We have a limited ability to monitor, test and treat radioactive patients. Radioiodine should virtually never be an emergency procedure in a severely debilitated patient.
Please submit all TT4 to reference lab. Due to high variability in in-house testing, we will ask for repeat testing if in-house results are sent to us for pre- or post-radioiodine thyroid values.
TSH is preferred over (or in addition to) fT4-ED to evaluate thyroid status, especially to confirm early cases or to diagnose iatrogenic hypothyroidism. We have the Truforma feline TSH and may ask that some tests are run at our clinic. TSH discussion
SDMA is available at Antech as an inexpensive add-on (code T1035.)
A full panel with U/A is needed 3 –4 wks after starting methimazole to assess safety and efficacy.
Please submit lab work including TT4 even if there is a reaction. 1. It may be our only chance to assess renal values with lower TT4. 2. Potential liver, bone marrow reactions need to be assessed.
If you perform radiographs at your clinic, please see below for guidelines
PRE (Required) Full lab panel to reference lab within 30 – 60 days pre-radioiodine. Timing is at OVSH doctor’s discretion based on overall health, co-morbidities, age.
PRE (Required) 3-view chest and abdomen with board-certified radiologist review within ~30 days prior to radioiodine. An Against Medical Advice will be needed if radiographs are declined.
PRE (Recommended) Pro-BNP or echocardiogram as auscultation and radiographs are notadequate to diagnose most cases of thyrotoxic cardiomyopathy.
POST (Required) Reference lab full panel with urine at 1, 3 and 6 months post-radioiodine.
We appreciate you referring to us and allowing us the privilege of treating your patients.