Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

    1. Darlene Metter1
    1. 1University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
      2San Antonio Military Medical Center, San Antonio, Texas, USA
      3Tennessee Valley VA Healthcare System, Nashville, Tennessee, USA
      4Vanderbilt University Medical Center, Nashville, Tennessee, USA
      5UAMS Thyroid Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
    1. Correspondence should be addressed to E A Wolin; Emails: ely.wolin{at} or lewolin{at}


    Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the post-operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175–200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.

    • Revision received 22 September 2014
    • Accepted 2 October 2014
    • Made available online as an Accepted Preprint 2 October 2014
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