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Does Radioactive Iodine Therapy for Hyperthyroidism Cause Cancer?

Brian W Kim1

  • 1Rush University Medical Center, Chicago, IL 60612, USA.

The Journal of Clinical Endocrinology and Metabolism
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Radioactive iodine (I-131) therapy for hyperthyroidism is generally considered safe. However, recent analyses suggest a potential increased cancer risk, prompting further investigation into its long-term safety.

Keywords:
cancerhyperthyroidismradioactive iodine

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Area of Science:

  • Nuclear Medicine
  • Endocrinology
  • Oncology

Background:

  • Radioactive iodine (I-131) has been a standard treatment for hyperthyroidism since the mid-20th century.
  • Previous studies, including the 1998 Cooperative Thyrotoxicosis Therapy Follow-up Study (CTTFUS), indicated I-131 safety regarding cancer risk.
  • A 2019 re-analysis of the CTTFUS cohort raised concerns about potential cancer risks associated with I-131 therapy.

Purpose of the Study:

  • To provide clinical context regarding the safety of radioactive iodine therapy for hyperthyroidism.
  • To discuss the controversy surrounding the 2019 re-analysis of the CTTFUS data.
  • To critically evaluate the evidence on I-131 and cancer risk.

Main Methods:

  • Review of pre-2019 literature on I-131 safety and cancer risk.
  • Discussion of the 2019 Kitahara et al. study and its 2020 follow-up.
  • Analysis of critical commentaries and lessons learned from the existing literature.

Main Results:

  • The preponderance of pre-2019 evidence suggested I-131 therapy was safe concerning cancer risk.
  • The 2019 re-analysis, using updated dosimetry, indicated an association between I-131 and increased mortality from overall, breast, and non-breast solid cancers.
  • The 2019 findings generated significant debate within the nuclear medicine community.

Conclusions:

  • The long-term safety of radioactive iodine therapy for hyperthyroidism remains a subject of ongoing discussion.
  • Clinicians require nuanced information to advise patients effectively regarding potential cancer risks.
  • Further research and critical evaluation of dosimetric models are essential.