A 7- to 8-cm diffuse toxic goiter with associated symptoms of hyperthyroidism developed in a 38-year-old black female undergoing regular hemodialysis for renal failure. Our treatment of choice was an ablative dose of radioactive iodine in the form of sodium iodide (Na-¹³¹I). To our knowledge, this is only the 4th documented case of hyperthyroidism in a patient with renal failure. Detailed monitoring of ¹³¹I radioactivity in the blood, thyroid gland and the dialysate demonstrated that there was no radiation hazard to personnel involved in the patient management.

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The uranium collimator of the Varian 4-MeV accelerator produces a dose rate of 100 mR/h near the collimator opening. It can be decreased to 4% by a 6-mm Lucite shield at the level of the collimator opening. A better solution is a lead glass-mylar (EM) shield which decreases the uranium radiation to less than 3% and also provides better skin sparing during treatment than the open collimator.