The Low Iodine Diet

The main follow up treatment for papillary thyroid carcinoma is a one off dose of radioactive iodine. Iodine 131. This has been the same for about 50 years. Other cancers are followed up with chemotherapy or radiotherapy or both, but thyroid cancer gets something a little different.

To prepare for the radioactive iodine (RAI), patients spend 2 weeks on a low iodine diet. In New Zealand we have very low amounts of iodine in our soils so the rules are not as stringent in some other countries, but the basic rules are:

Low Iodine Rules New Zealand (please follow the instructions from your Oncologist if they differ)
No seafood
No fish oil capsules
No commercial breads because they have iodine added
No vitamin supplements containing iodine
No products containing iodised salt
Limit eggs and dairy products (milk, butter, cheese, yoghurt)
No sea salt, Himalayan salt or iodised table salt ( plain salt is ok)
No processed meats such as ham, salami, or luncheon.
No red food coloring

Suggested New Zealand shopping list for the Low iodine diet
Olivani
Any cooking oil you prefer
Leggo no salt added tomato paste
Campbell's No Salt Added Stock
No salt added tinned tomatoes
Trident Coconut milk and light coconut milk
Plain table salt
Dried or fresh herbs
Pasta i.e dry spaghetti, elbows etc (not tinned)
Egg whites (the yolks have iodine)
Plain flour, yeast, baking soda etc
Plain porridge oats
Homemade muesli (make your own)
Cereals from the health food store which have no salt or milk powder added
Ingredients to make your own bread
All salads and vegetables
All fruits
Unsalted nuts
Kiwicrush
Whittakers dark chocolate cacao 62% and Dark Ghana 72% are dairy free (check the label for others)
Lollies and sugar free lolls

Lunches
Homemade bread, homemade hummus, salad, tomatoes, leftover chicken, beef or lamb from dinner the night before

Dinners
Chicken, beef, lamb
Potatoes
Veggies

Desserts
Baking - use plain salt
Fruit
Gelato ( check the ingredients)

Snacks
Home baking
unsalted nuts

I tended to be more stringent with my diet as I wanted to get the best result that I could. Here are some things that I did.

I found that Olivani margarines contain no dairy products so I rang them and they confirmed that they do not use iodised salt. So Olivani is safe to use on the LID diet.

I made all my own bread. I ended up with two good recipes , both are in the Alison Holst The New Zealand bread Book. We chose the 5 seed loaf and the French bread recipe, and just used plain table salt instead of iodised salt.

I used avocado as a spread or Pic's unsalted peanut Butter, or Olivani.

I made Dukkah and ate it with olive oil on fresh home made bread.

I used some free recipes from the Low Iodine Cookbook which can be found online at www.thyca.org which is Thyca: Thyroid cancer Survivors Association Inc.

I made oat and raisin cookies to use for snacks instead of muesli bars or biscuits.

For breakfast I had porridge and made my own almond milk, if you click on the words you get to the Youtube video which shows how to make it.
Almond Milk
Soak 1 cup of almonds in cold water overnight
In the morning drain and put in blender with 3-4 cups of cold water
Whizz in blender , then add some sugar or sweetener and a teaspoon of vanilla
Whizz, strain through cheesecloth, squeeze out till you are left with milk in the bowl and dry crumbs of almonds which can be dried in the oven and used for cooking later.

Dinners were easy. Potatoes, vegetables and meat or chicken are all ok to eat, as are home cooked (not tinned) chickpeas and other beans.

I found the hardest thing was to find crackers, I craved salty crispy crackers. A friend made me some of Anabel Langbeins sesame lavosh crackers.

The diet was quite easy to follow as long as you can cook, it would be much harder if you who normally live on takeaways, as you would not be able to have anything except fruit salad for 2 weeks!

I did miss being able to buy lunch. If I was out of the house and hungry I had unsalted nuts or fruit, a diet coke or fruit drink, a fruit salad or salad with no dressing.

Going Hypo!
Whilst following the Low Iodine Diet,  you are usually asked to stop taking your thyroxine tablets. (some people have injections of Thyrogen and they get different instructions). When your body is low in thyroxine, the pituitary gland which is in your brain makes a hormone called Thyroid Stimulating Hormone (TSH). As your TSH goes up, you become more and more slow, tired, constipated, absent minded, you may want to sleep all the time or you may get insomnia, you may get dry eyes and tingling in your fingers and toes. I got most of these symptoms, I felt tired during the day and couldn't sleep at night.
The TSH tells any thyroid cells left in your body to grow and make thyroxine which your body needs for all sorts of metabolic processes.
The  cells are desperate for iodine and trying to grow . and when you are given  the radio-iodine capsule (or drink) at the hospital the leftover thyroid cells and thyroid cancer cells suck up the iodine and are slowly killed by the radiation.

The day after you are given the radioactive iodine you usually can return to a normal diet and your oncologist will let you know when to start taking Thyroxine tablets again. In New Zealand the Levothyroxine pills available are Eltroxin, Synthroid and Goldshield. if you don't express a preference you usually get given Eltroxin.