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Radioactive iodine for differentiated thyroid carcinoma.

Saumya Sunny1, Kathryn Graham2, Julie Hephzibah1

  • 1Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India.

Current Opinion in Endocrinology, Diabetes, and Obesity
|October 10, 2025
PubMed
Summary

Radioactive iodine (RAI) may be safely omitted in many low-risk differentiated thyroid cancer (DTC) cases. Management for intermediate-risk DTC is evolving, with molecular genotyping guiding future RAI decisions.

Keywords:
differentiated thyroid carcinomaradioactive iodine ablationradioactive iodine refractory disease

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Endocrinology

Background:

  • Radioactive iodine (RAI) is utilized in differentiated thyroid cancer (DTC) for thyroid remnant ablation and residual disease treatment.
  • Current guidelines for RAI use in DTC vary, necessitating a review focused on low-risk DTC and randomized trials.

Purpose of the Study:

  • To compare guidelines on the use of RAI in DTC.
  • To focus on randomized trials in low-risk DTC.
  • To explore molecular genotyping's role in advanced RAI-refractory DTC.

Main Methods:

  • Review of guidelines and randomized trials concerning RAI use in DTC.
  • Analysis of data from ESTIMABL2 and IoN trials.
  • Consideration of molecular genotyping in advanced DTC.

Main Results:

  • The ESTIMABL2 and IoN trials suggest surveillance is adequate for low-risk DTC post-thyroidectomy.
  • RAI practice is becoming risk-adapted, with tailored activity and dosimetry.
  • Systemic therapy choices are crucial for RAI-refractory DTC.

Conclusions:

  • RAI use in DTC is shifting to a risk-adapted approach.
  • Evidence supports withholding RAI in many low-risk DTC patients.
  • Optimal management for intermediate-risk DTC requires further research, potentially utilizing molecular data.