2025 Korean Thyroid Association Management Guidelines for Radioactive Iodine Therapy in Patients with Hyperthyroidism

Area of Science:

• Endocrinology
• Nuclear Medicine
• Clinical Practice Guidelines

Background:

• Hyperthyroidism, often caused by Graves' disease, involves excessive thyroid hormone production.
• Current treatment options include antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and thyroidectomy.
• Standardized clinical recommendations for RAI therapy are needed to ensure safety, efficacy, and proper monitoring.

Purpose of the Study:

• To develop evidence-based clinical recommendations for radioactive iodine therapy in hyperthyroidism.
• To establish standardized protocols for RAI therapy focusing on safety, efficacy, and patient monitoring.
• To provide updated guidance for Korean clinicians managing hyperthyroidism with RAI.

Main Methods:

• Expert consensus was used to identify six key clinical questions regarding RAI therapy.
• A systematic literature review was conducted covering studies published between 2013 and 2022.
• Clinical indications for RAI were categorized into recommended, may be considered, and not recommended groups.

Main Results:

• A fixed RAI dose of 10 to 15 mCi is recommended.
• Avoiding iodine-rich foods for 1 week pre-treatment is advised; a strict low-iodine diet is unnecessary.
• Antithyroid drugs (ATD) should be stopped 3-7 days before RAI and may be resumed.
• Prophylactic glucocorticoids are recommended for mild thyroid eye disease.
• Thyroid function monitoring is recommended post-treatment at 4-6 weeks, then every 2-3 months until stable, followed by 6-12 month intervals.

Conclusions:

• These guidelines provide a framework for standardized RAI therapy in hyperthyroidism.
• Individualized treatment decisions should consider clinical features, comorbidities, and patient preferences.
• The guidelines emphasize recent advancements in RAI therapy and its safe application in Korea.