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Molecular Mechanisms of Radioiodine Refractoriness in Differentiated Thyroid Cancer: Focus on Sodium/Iodide Symporter

Vladimir D Rokashkov1, Liudmila V Spirina1,2, Natalya V Tarasenko1

  • 1Biochemistry and Molecular Biology Division, Siberian State Medical University, 2 Moskovsky Trakt, Tomsk 634050, Russia.

Current Issues in Molecular Biology
|April 27, 2026
PubMed

Insights

Radioiodine therapy for differentiated thyroid cancer (DTC) can fail due to sodium/iodide symporter (NIS) issues. Understanding NIS dysregulation mechanisms is key to overcoming radioiodine refractoriness in DTC.

Area of Science:

  • Oncology
  • Molecular Biology
  • Endocrinology

Background:

  • The sodium/iodide symporter (NIS/SLC5A5) is crucial for radioiodine therapy efficacy in differentiated thyroid cancer (DTC).
  • Radioiodine refractoriness in DTC is a significant clinical challenge, limiting treatment options.

Purpose of the Study:

  • To review the molecular mechanisms causing NIS dysregulation and radioiodine refractoriness in DTC.
  • To explore potential redifferentiation strategies for restoring radioiodine uptake.

Main Methods:

  • This is a narrative review examining existing literature on NIS function and regulation in DTC.
  • Analysis of molecular pathways, epigenetic modifications, and genetic alterations impacting NIS.

Main Results:

  • NIS dysregulation in refractory DTC involves transcriptional suppression (MAPK/ERK, PI3K/AKT), epigenetic silencing, impaired trafficking, and microRNA regulation.
  • Genetic mutations (BRAF V600E, TERT promoter) correlate with dedifferentiation and poor radioiodine response.
  • Redifferentiation agents targeting MAPK pathways show promise in restoring iodine uptake in specific patient groups.

Conclusions:

  • Multiple molecular mechanisms contribute to radioiodine refractoriness in DTC by affecting NIS.
  • Targeted therapies and understanding these mechanisms can guide improved patient stratification and treatment decisions for refractory DTC.
Keywords:
NIS (sodium/iodide symporter)biomarkersmicroRNAsradioiodine refractorinessthyroid cancer

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