Iodine-131
From Wikipedia, the free encyclopedia
Iodine-131 (
131I), also called
radioiodine, is an important
radioisotope of
iodine.
It has a radioactive decay half-life of about eight days. It is
associated with nuclear energy, medical diagnostic and treatment
procedures, and natural gas production. It also plays a major role as a
radioactive isotope present in
nuclear fission products, and was a significant contributor to the health hazards from open-air atomic bomb testing in the 1950s, and from the
Chernobyl disaster, as well as being a large fraction of the contamination hazard in the first weeks in the
Fukushima nuclear crisis. This is because I-131 is a major
uranium,
plutonium fission product, comprising nearly 3% of the total products of fission (by weight). See
fission product yield for a comparison with other radioactive fission products. I-131 is also a major fission product of uranium-233, produced from
thorium.
Due to its mode of
beta decay, iodine-131 is notable for causing
mutation
and death in cells that it penetrates, and other cells up to several
millimeters away. For this reason, high doses of the isotope are
sometimes less dangerous than low doses, since they tend to kill
thyroid
tissues that would otherwise become cancerous as a result of the
radiation. For example, children treated with moderate dose of I-131 for
thyroid adenomas had a detectable increase in thyroid cancer, but
children treated with a much higher dose did not. Likewise, most studies
of very-high-dose I-131 for treatment of
Graves disease
have failed to find any increase in thyroid cancer, even though there
is linear increase in thyroid cancer risk with I-131 absorption at
moderate doses.
[1]
Thus, iodine-131 is increasingly less employed in small doses in
medical use (especially in children), but increasingly is used only in
large and maximal treatment doses, as a way of killing targeted tissues.
This is known as "therapeutic use."
Iodine-131 can be "seen" by
nuclear medicine imaging techniques (i.e.,
gamma cameras)
whenever it is given for therapeutic use, since about 10% of its energy
and radiation dose is via gamma radiation. However, since the other 90%
of radiation (beta radiation) causes tissue damage without contributing
to any ability to see or "image" the isotope, other less-damaging
radioisotopes of iodine are preferred in situations when
only
nuclear imaging is required. The isotope I-131 is still occasionally
used for purely diagnostic (i.e., imaging) work, due to its low expense
compared to other iodine radioisotopes. Very small medical imaging doses
of I-131 have not shown any increase in thyroid cancer. The low-cost
availability of I-131, in turn, is due to the relative ease of creating
I-131 by neutron bombardment of natural
tellurium
in a nuclear reactor, then separating I-131 out by various simple
methods (i.e., heating to drive off the volatile iodine). By contrast,
other iodine radioisotopes are usually created by far more expensive
techniques, starting with reactor radiation of expensive capsules of
pressurized
xenon gas.
Iodine-131 is also one of the most commonly used gamma-emitting
radioactive industrial tracer. Radioactive tracer isotopes are injected with
hydraulic fracturing fluid to determine the injection profile and location of fractures created by hydraulic fracturing.
[2]
Much smaller incidental doses of iodine-131 than those used in
medical therapeutic procedures, are thought to be the major cause of
increased thyroid cancers after accidental nuclear contamination.
[3][4][5][6]
These cancers happen from residual tissue radiation damage caused by
the I-131, and usually appear years after exposure, long after the I-131
has decayed.
[3]
Production
Most I-131 production is from nuclear reactor neutron-
irradiation of a natural
tellurium
target. Irradiation of natural tellurium produces almost entirely I-131
as the only radionuclide with a half-life longer than hours, since most
lighter
isotopes of tellurium
become heavier stable isotopes, or else stable iodine or xenon.
However, the heaviest naturally-occurring tellurium nuclide, Te-130 (34%
of natural Te) absorbs a neutron to become tellurium-131, which
beta-decays with a half-life of 25 minutes, to I-131.
A tellurium compound can be irradiated while bound as an oxide to an ion exchange column, and evolved I-131 then
eluted into an alkaline solution.
[7]
More commonly, powdered elemental tellurium is irradiated and then
I-131 separated from it by dry distillation of the iodine, which has a
far higher vapor pressure. The element is then dissolved in a mildly
alkaline solution in the standard manner, to produce I-131 as iodide and
hypoiodate (which is soon reduced to iodide).
[8]
131I is a
fission product with a
yield of 2.878% from
uranium-235,
[9] and can be released in
nuclear weapons tests and
nuclear accidents. However, the short half-life means it is not present in significant quantities in cooled
spent nuclear fuel, unlike
iodine-129 whose half-life is nearly a billion times that of I-131.
Radioactive decay
Iodine-131 decay scheme (simplified)
I-131 decays with a
half-life of 8.02 days with
beta minus and
gamma emissions. This
nuclide of iodine has 78
neutrons in its nucleus, while the only stable nuclide,
127I, has 74. On decaying,
131I most often (89% of the time) expends its 971 keV of decay energy by transforming into the stable
131Xe (Xenon) in two steps, with gamma decay following rapidly after beta decay:
+ 606 keV
+ 364 keV
The primary emissions of
131I decay are thus electrons
with a maximal energy of 606 keV (89% abundance, others 248–807 keV) and
364 keV gamma rays (81% abundance, others 723 keV).
[10] Beta decay also produces an
antineutrino,
which carries off variable amounts of the beta decay energy. The
electrons, due to their high mean energy (190 keV, with typical
beta-decay spectra present) have a tissue penetration of 0.6 to 2 mm.
[11]
Effects of exposure
Iodine in food is absorbed by the body and preferentially concentrated in the
thyroid where it is needed for the functioning of that gland. When
131I is present in high levels in the environment from radioactive
fallout,
it can be absorbed through contaminated food, and will also accumulate
in the thyroid. As it decays, it may cause damage to the thyroid. The
primary risk from exposure to high levels of
131I is the chance occurrence of
radiogenic thyroid cancer in later life. Other risks include the possibility of non-cancerous growths and
thyroiditis.
[1]
The risk of thyroid cancer in later life appears to diminish with
increasing age at time of exposure. Most risk estimates are based on
studies in which radiation exposures occurred in
children
or teenagers. When adults are exposed, it has been difficult for
epidemiologists to detect a statistically significant difference in the
rates of thyroid disease above that of a similar but otherwise-unexposed
group.
[1]
The risk can be mitigated by taking iodine supplements, raising the
total amount of iodine in the body and, therefore, reducing uptake and
retention in the face and chest and lowering the relative proportion of
radioactive iodine. However, such supplements were not distributed to
the population living nearest to the
Chernobyl nuclear power plant after the disaster,
[13] though they were widely distributed to children in Poland.
Within the USA, the highest
131I fallout doses occurred
during the 1950s and early 1960s to children having consumed fresh
sources of milk contaminated as the result of above-ground testing of
nuclear weapons.
[3] The
National Cancer Institute provides additional information on the health effects from exposure to
131I in fallout,
[14]
as well as individualized estimates, for those born before 1971, for
each of the 3070 counties in the USA. The calculations are taken from
data collected regarding fallout from the nuclear weapons tests
conducted at the
Nevada Test Site.
[15]
On 27 March 2011, the Massachusetts Department of Public Health reported that
131I
was detected in very low concentrations in rainwater from samples
collected in Massachusetts, USA, and that this likely originated from
the Fukushima power plant.
[16]
Farmers near the plant dumped raw milk, while testing in the United
States found 0.8 pico-curies per liter of iodine-131 in a milk sample,
but the radiation levels were 5,000 times lower than the FDA's "defined
intervention level." The levels were expected to drop relatively quickly
[17]
Treatment and prevention
A common treatment method for preventing iodine-131 exposure is by
saturating the thyroid with regular, non-radioactive iodine-127, as an
iodide or
iodate
salt. Free elemental iodine should not be used for saturating the
thyroid because it is a corrosive oxidant and therefore is toxic to
ingest in the necessary quantities
[citation needed].
The thyroid will absorb very little of the radioactive iodine-131 after
it is saturated with non-radioactive iodide, thereby avoiding the
damage caused by radiation
from radioiodine. The most common method of treatment is to give
potassium iodide to those at risk. The dosage for adults is 130 mg
potassium iodide per day, given in one dose, or divided into portions of
65 mg twice a day. This is equivalent to 100 mg of iodide, and is about
7000 times bigger than the nutritional dose of iodide, which is
0.015 mg per day (150
micrograms per day). See
potassium iodide for more information on prevention of radioiodine absorption by the thyroid during nuclear accident, or for
nuclear medical
reasons. The FDA-approved dosing of potassium iodide for this purpose
are as follows: infants less than 1 month old, 16 mg; children 1 month
to 3 years, 32 mg; children 3 years to 18 years, 65 mg; adults 130 mg.
[18] However, some sources recommend alternative dosing regimens.
[19]
The World Health Organizations daily recommended Dosage for Radiological Emergencies involving radioactive iodine[20]
| Age |
KI in mg |
KIO3 in mg |
| Over 12 years old |
130 |
170 |
| 3 – 12 years old |
65 |
85 |
| 1 – 36 months old |
32 |
42 |
| < 1 month old |
16 |
21 |
The ingestion of prophylaxis iodide &
iodate
is not without its dangers, There is reason for caution about taking
potassium iodide or iodine supplements, as their unnecessary use can
cause conditions such as the
Jod-Basedow phenomena, and the
Wolff-Chaikoff effect, trigger and/or worsen
hyperthyroidism and
hypothyroidism respectively, and ultimately cause temporary or even permanent thyroid conditions. It can also cause
sialadenitis
(an inflammation of the salivary gland), gastrointestinal disturbances,
allergic reactions and rashes. Potassium iodide is also not recommended
for those who have had an allergic reaction to iodine, and people with
dermatitis herpetiformis and hypocomplementemic vasculitis, conditions
that are linked to a risk of iodine sensitivity.
[21]
The use of a particular 'Iodine tablet' used in
portable water purification
has also been determined as somewhat effective at reducing radioiodine
uptake. In a small study on human subjects, who for each of their 90 day
trial, ingested four 20 milligram tetraglycine hydroperiodide(TGHP)
water tablets, with each tablet releasing 8 milligrams (ppm) of free
titratable iodine;
[22]
it was found that the biological uptake of radioactive iodine in these
human subjects dropped to, and remained at, a value of less than 2% the
radioiodine uptake rate of that observed in control subjects who went
fully exposed to radioiodine without treatment.
[23]
The administration of known
goitrogen substances can also be used as a
prophylaxis in reducing the bio-uptake of iodine, (whether it be the nutritional non-radioactive
iodine-127 or radioactive iodine, radioiodine - most commonly iodine-131, as the body cannot discern between different iodine
isotopes).
Perchlorate ions, a common water contaminant in the USA due to the
aerospace industry, has been shown to reduce iodine uptake and thus is classified as a
goitrogen.
Perchlorate ions are a competitive inhibitor of the process by which
iodide, is actively deposited into thyroid follicular cells. Studies
involving healthy adult volunteers determined that at levels above 0.007
milligrams per kilogram per day (mg/(kg·d)), perchlorate begins to
temporarily inhibit the thyroid gland’s ability to absorb iodine from
the bloodstream ("iodide uptake inhibition", thus perchlorate is a known
goitrogen).
[24]
The reduction of the iodide pool by perchlorate has dual
effects—reduction of excess hormone synthesis and hyperthyroidism, on
the one hand, and reduction of thyroid inhibitor synthesis and
hypothyroidism on the other. Perchlorate remains very useful as a single
dose application in tests measuring the discharge of radioiodide
accumulated in the thyroid as a result of many different disruptions in
the further metabolism of iodide in the thyroid gland.
[25]
Treatment of thyrotoxicosis (including Graves' disease) with
600-2,000 mg potassium perchlorate (430-1,400 mg perchlorate) daily for
periods of several months or longer was once common practice,
particularly in Europe,
[24][26] and perchlorate use at lower doses to treat thryoid problems continues to this day.
[27]
Although 400 mg of potassium perchlorate divided into four or five
daily doses was used initially and found effective, higher doses were
introduced when 400 mg/day was discovered not to control thyrotoxicosis
in all subjects.
[24][25]
Current regimens for treatment of
thyrotoxicosis
(including Graves' disease), when a patient is exposed to additional
sources of iodine, commonly include 500 mg potassium perchlorate twice
per day for 18–40 days.
[24][28]
Prophylaxis with perchlorate containing water at concentrations of 17
ppm,
which corresponds to 0.5 mg/kg-day personal intake, if one is 70 kg and
consumes two litres of water per day, was found to reduce baseline
radioiodine uptake by 67%
[24]
This is equivalent to ingesting a total of just 35 mg of perchlorate
ions per day. In another related study were subjects drank just 1 litre
of perchlorate containing water per day at a concentration of 10 ppm,
i.e. daily 10 mg of perchlorate ions were ingested, an average 38%
reduction in the uptake of iodine was observed.
[29]
However when the average perchlorate absorption in perchlorate plant
workers subjected to the highest exposure has been estimated as
approximately 0.5 mg/kg-day, as in the above paragraph, a 67% reduction
of iodine uptake would be expected. Studies of chronically exposed
workers though have thus far failed to detect any abnormalities of
thyroid function, including the uptake of iodine.
[30]
this may well be attributable to sufficient daily exposure or intake of
healthy iodine-127 among the workers and the short 8 hr
biological half life of perchlorate in the body.
[24]
To completely block the uptake of iodine-131 by the purposeful
addition of perchlorate ions to a populaces water supply, aiming at
dosages of 0.5 mg/kg-day, or a water concentration of 17 ppm, would
therefore be grossly inadequate at truly reducing radioiodine uptake.
Perchlorate ion concentrations in a regions water supply, would
therefore need to be much higher, with at least a total dosage of
7.15 mg/kg of body weight per day needing to be aimed for, with this
being achievable for most adults by consuming 2 liters of water per day
with a water concentration of 250 mg/kg of water or 250 ppm of
perchlorate ions per liter, only at this level would perchlorate
consumption offer adequate protection, and be truly beneficial to the
population at preventing
bioaccumulation when exposed to a radioiodine environment.
[24][28] This being entirely independent of the availability of
iodate or
iodide drugs.
The continual addition of perchlorate to the water supply would need
to continue for no less than 80–90 days, beginning immediately after the
initial release of radioiodine was detected, after 80–90 days had
passed released radioactive iodine-131 would have decayed to less than
0.1% of its initial quantity and thus the danger from biouptake of
iodine-131 is essentially over.
[31]
In the event of a radioiodine release the ingestion of prophylaxis
potassium iodide or iodate, if available, would rightly take precedence
over perchlorate administration and would be the first line of defense
in protecting the population from a radioiodine release. However in the
event of a radioiodine release too massive and widespread to be
controlled by the limited stock of iodide & iodate prophylaxis
drugs, then the addition of perchlorate ions to the water supply, or
distribution of perchlorate tablets would serve as a cheap, efficacious,
second line of defense against
carcinogenic radioiodine bioaccumulation.
The ingestion of goitrogen drugs is, much like
potassium iodide is also not without its dangers, such as
hypothyroidism.
In all these cases however, despite the risks, the prophylaxis benefits
of intervention with iodide, iodate or perchlorate outweigh the serious
cancer risk from radioiodine
bioaccumulation in regions were radioiodine has sufficiently contaminatated the environment.
Medical and pharmaceutical uses
A
pheochromocytoma tumor is seen as a dark sphere in the center of the body (it is in the left adrenal gland). The image is by
MIBG scintigraphy,
showing the tumor by radiation from radioiodine in the MIBG. Two images
are seen of the same patient from front and back. The image of the
thyroid in the neck is due to unwanted uptake of radioiodine (as iodide)
by the thyroid, after breakdown of the radioactive iodine-containing
medication. Accumulation at the sides of the head is from salivary gland
due to uptake of I-131 mIBG by the sympathetic neuronal elements in the
salivary glands.Meta-[I-131]iodobenzylguanidine is a radio-labeled
analog of the adrenergic blocking agent guanethidine.Radioactivity is
also seen from uptake by the liver, and excretion by the kidneys with
accumulation in the bladder.
It is used in
nuclear medicine therapeutically and can also be seen with diagnostic scanners if it has been used therapeutically. Use of the
131I as iodide salt exploits the mechanism of absorption of iodine by the normal cells of the
thyroid gland. Examples of its use in
radiation therapy are those where tissue destruction is desired after iodine uptake by the tissue.
Major uses of
131I include the treatment of
thyrotoxicosis (hyperthyroidism) and some types of
thyroid cancer that absorb iodine. The
131I is thus used as direct
radioisotope therapy to treat
hyperthyroidism due to
Graves' disease,
and sometimes hyperactive thyroid nodules (abnormally active thyroid
tissue that is not malignant). The therapeutic use of radioiodine to
treat hyperthyroidism from Graves' disease was first reported by
Saul Hertz in 1941.
The
131I isotope is also used as a radioactive label for certain
radiopharmaceuticals that can be used for therapy, e.g.
131I-
metaiodobenzylguanidine (
131I-MIBG) for imaging and treating
pheochromocytoma and
neuroblastoma. In all of these therapeutic uses,
131I destroys tissue by short-range
beta radiation.
About 90% of its radiation damage to tissue is via beta radiation, and
the rest occurs via its gamma radiation (at a longer distance from the
radioisotope). It can be seen in diagnostic scans after its use as
therapy, because
131I is also a gamma-emitter.
Because of the carcinogenicity of its beta radiation in the thyroid
in small doses, I-131 is rarely used primarily or solely for diagnosis
(although in the past this was more common due to this isotope's
relative ease of production and low expense). Instead the more purely
gamma-emitting radioiodine
iodine-123 is used in diagnostic testing (
nuclear medicine scan of the thyroid). The longer half-lived
iodine-125 is also occasionally used when a longer half-life radioiodine is needed for diagnosis, and, in
brachytherapy
treatment (isotope confined in small seed-like metal capsules), where
the low-energy gamma radiation without a beta component, makes
iodine-125 useful. The other radioisotopes of iodine are never used in
brachytherapy.
The use of
131I as a medical isotope has been blamed for a routine shipment of
biosolids being rejected from crossing the Canada—U.S. border.
[32] Such material can enter the sewers directly from the medical facilities, or by being excreted by patients after a treatment.
Administration of therapeutic I-131
Because the total radioactivity of a dose of I-131 is usually high,
and because the local beta radiation of nearby stomach tissue from an
undissolved capsule is high, I-131 is usually administered to human
patients in a small drink containing a few ounces of fluid. This is
often slowly and carefully sucked out of a shielded container to prevent
spillage.
[33]
For administration to animals (for example, cats with hyperthyroidism)
for practical reasons the isotope must be administered by injection.
Post-treatment isolation
Patients receiving I-131 radioiodine treatment are warned not to have
sexual intercourse for one month (or shorter, depending on dose given),
and women are told not to become pregnant for six months afterwards.
"This is because a theoretical risk to a developing fetus exists, even
though the amount of radioactivity retained may be small and there is no
medical proof of an actual risk from radioiodine treatment. Such a
precaution would essentially eliminate direct fetal exposure to
radioactivity and markedly reduce the possibility of conception with
sperm that might theoretically have been damaged by exposure to
radioiodine."
[34]
These guidelines vary from hospital to hospital and will depend also on
the dose of radiation given. Some also advise not to hug or hold
children when the radiation is still high, and a one or two metre
distance to others may be recommended.
[35]
I-131 will be eliminated from the body over the next several weeks
after it is given. The majority of I-131 will be eliminated from the
human body in 3–5 days, through natural decay, and through excretion in
sweat and urine. Smaller amounts will continue to be released over the
next several weeks, as the body processes thyroid hormones created with
the I-131. For this reason, it is advised to regularly clean toilets,
sinks, bed sheets and clothing used by the person who received the
treatment. Patients may also be advised to wear slippers or socks at all
times, and themselves physically isolated from others. This minimizes
accidental exposure by family members, especially children.
[36]
Use of a decontaminant specially made for radioactive iodine removal
may be advised. The use of chlorine bleach solutions, or cleaners that
contain chlorine bleach for cleanup, are not advised, since radioactive
elemental iodine gas may be released.
[37] Airborne I-131 may cause a greater risk of second-hand exposure, spreading contamination over a wide area.
Many airports now have radiation detectors to detect the smuggling of
radioactive materials that may be used in nuclear weapons manufacture.
Patients should be warned that if they travel by air, they may trigger
radiation detectors at airports up to 95 days after their treatment with
131I.
[38]
Industrial radioactive tracer uses
Used for the first time in 1951 to localize leaks in a drinking water supply system of
Munich, Germany, iodine-131 became one of the most commonly used gamma-emitting industrial
radioactive tracer with applications in
isotope hydrology and leak detection.
[39][40][41][42]
Since late 1940s, radioactive tracers have been used by the oil
industry. Tagged at the surface, water is then tracked downhole, using
the appropriated gamma detector, to determine flows and detect
underground leaks. I-131 has been the most widely used tagging isotope
in an aqueous solution of sodium iodine.
[2][43][44] It is used to characterize the
hydraulic fracturing fluid to help determine the injection profile and location of fractures created by
hydraulic fracturing.
[45][46][47]
See also
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