A 35-year-old woman comes to the office because of tremors, weakness, weight loss despite an increased appetite, frequent bowel movements, and "itchy legs." She does not drink alcohol or caffeine and she does not smoke cigarettes. She appears anxious and fidgety, and has a "frightened" look. Her blood pressure is 120/80 mm Hg and pulse is 88/min. Physical examination shows a proptosis with stare and lid lag. The thyroid gland is lobular and asymmetrically enlarged. There are waxy, infiltrated plaques over the dorsum of her legs and the affected area has a peau d'orange appearance. An ECG shows sinus tachycardia. Laboratory studies show:
TSH : undetectable
Thyroxine : 20 ug/dl
Treatment options are discussed, and she decides upon radioactive iodine. In discussing radioactive iodine therapy with the patient, you should inform her that
A. continuous or repeated doses of radioiodine are usually necessary
B. hepatitis, arthralgias, agranulocytosis, and a rash are common side effects of radioiodine therapy
C. patients treated with radioiodine will often require replacement doses of thyroid hormone within 10 years
D. radioiodine therapy is the treatment of choice if she is currently pregnant
E. there is plenty of evidence that the dose of radioiodine that she will receive has leukemogenic effects
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