Radioactive iodine therapy: multiple faces of the same polyhedron

Area of Science:

• Endocrinology
• Oncology
• Nuclear Medicine

Background:

• Rising incidence of differentiated thyroid carcinoma (DTC), particularly low-risk papillary thyroid cancer (PTC), leads to concerns about overdiagnosis and overtreatment.
• Traditional
• one size fits all
• management strategies for DTC are being questioned due to psychological, financial, and clinical consequences.
• Current thyroid cancer guidelines advocate for risk-adapted management, tailoring therapy intensity to individual recurrence and mortality risk.

Purpose of the Study:

• To review factors influencing the decision for radioactive iodine therapy (RIT) in differentiated thyroid carcinoma (DTC).
• To present a risk-adapted approach for selecting patients eligible for RIT, emphasizing peri-operative risk stratification.
• To address the ongoing debate surrounding the routine use of RIT in DTC management.

Main Methods:

• Review of current literature on the benefits and risks of radioactive iodine therapy (RIT) in differentiated thyroid carcinoma (DTC).
• Analysis of clinical, imaging, medical team, and patient-specific factors for RIT evaluation.
• Emphasis on peri-operative risk stratification as a guiding principle for RIT recommendations.

Main Results:

• Recent guidelines support selective RIT use, especially for low-to-intermediate risk DTC.
• Patient selection for RIT remains a complex issue with ongoing debate regarding optimal benefit and risk assessment.
• Peri-operative risk stratification emerges as a key tool for guiding RIT decisions.

Conclusions:

• A risk-adapted strategy is crucial for managing differentiated thyroid carcinoma (DTC), moving away from uniform treatment protocols.
• Selective use of radioactive iodine therapy (RIT) is recommended for carefully selected patients with low-risk DTC.
• Peri-operative risk stratification should guide the initial management recommendations for RIT in DTC.