Skip to main content

Radioiodine Therapy of Thyroid Cancer

  • Chapter
  • First Online:
Nuclear Medicine Therapy
  • 856 Accesses

Abstract

Differentiated thyroid cancer (DTC) is usually treated by surgery, followed by radioiodine therapy (RIT) in most cases. As with any therapy, RIT has a number of possible side effects. While these are few and mostly minor in comparison with other oncological therapies, they may nonetheless impose a significant burden on patients’ quality of life.

This chapter will review DTC treatment, especially with RIT, as well as potential side effects and possible strategies to avoid or minimize these.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Parkin DM, Muir CS, Whelan SL, Gao YT, Ferlay J, Powell J. In: IARC scientific publications, editor. Cancer incidence in five continents, vol. vol. 6. Lyon, France: International Agency for Research on Cancer; 1992.

    Google Scholar 

  2. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297–306.

    Article  CAS  Google Scholar 

  3. Verburg FA, Mader U, Luster M, Reiners C. Histology does not influence prognosis in differentiated thyroid carcinoma when accounting for age, tumour diameter, invasive growth and metastases. Eur J Endocrinol. 2009;160:619–24.

    Article  CAS  Google Scholar 

  4. Verburg FA, Mader U, Tanase K, Thies ED, Diessl S, Buck AK, Luster M, Reiners C. Life expectancy is reduced in differentiated thyroid cancer patients >= 45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients. J Clin Endocrinol Metab. 2013;98:172–80.

    Article  CAS  Google Scholar 

  5. Tanase K, Thies ED, Mader U, Reiners C, Verburg FA. The TNM system (version 7) is the most accurate staging system for the prediction of loss of life expectancy in differentiated thyroid cancer. Clin Endocrinol. 2016;84(2):284–91.

    Article  Google Scholar 

  6. Hedinger C, Williams ED, Sobin LH. Histological typing of thyroid tumours. No. 11 of international histologic classification of tumours. Berlin: Springer-Verlag; 1988.

    Book  Google Scholar 

  7. Rosai J, Carcangiu ML, Delellis RA. Tumors of the thyroid gland. Atlas of tumor pathology, 3rd series. Fascicle 5. Armed Forces Institute of Pathology: Washington, D.C; 1992.

    Google Scholar 

  8. Kloos RT, Mazzaferri E. Thyroid carcinoma. In: Cooper DS, editor. Medical management of thyroid disease. New York: Marcel Dekker Inc.; 2001.

    Google Scholar 

  9. Shattuck TM, Westra WH, Ladenson PW, Arnold A. Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. N Engl J Med. 2005;352:2406–12.

    Article  CAS  Google Scholar 

  10. Simpson WJ, Panzarella T, Carruthers JS, Gospodarowicz MK, Sutcliffe SB. Papillary and follicular thyroid cancer: impact of treatment in 1578 patients. Int J Radiat Oncol Biol Phys. 1988;14:1063–75.

    Article  CAS  Google Scholar 

  11. Hay ID, Bergstralh EJ, Grant CS, McIver B, Thompson GB, van Heerden JA, Goellner JR. Impact of primary surgery on outcome in 300 patients with pathologic tumor-node-metastasis stage III papillary thyroid carcinoma treated at one institution from 1940 through 1989. Surgery. 1999;126:1173–81.

    Article  CAS  Google Scholar 

  12. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998;124:958–64.

    Article  CAS  Google Scholar 

  13. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–28.

    Article  CAS  Google Scholar 

  14. Tsang RW, Brierley JD, Simpson WJ, Panzarella T, Gospodarowicz MK, Sutcliffe SB. The effects of surgery, radioiodine, and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma. Cancer. 1998;82:375–88.

    Article  CAS  Google Scholar 

  15. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102:1088–95.

    CAS  PubMed  Google Scholar 

  16. Duren M, Yavuz N, Bukey Y, Ozyegin MA, Gundogdu S, Acbay O, Hatemi H, Uslu I, Onsel C, Aksoy F, Oz F, Unal G, Duren E. Impact of initial surgical treatment on survival of patients with differentiated thyroid cancer: experience of an endocrine surgery center in an iodine-deficient region. World J Surg. 2000;24:1290–4.

    Article  CAS  Google Scholar 

  17. Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg. 1992;16:711–6.

    Article  CAS  Google Scholar 

  18. Cheah WK, Arici C, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Complications of neck dissection for thyroid cancer. World J Surg. 2002;26:1013–6.

    Article  Google Scholar 

  19. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000;24:1335–41.

    Article  CAS  Google Scholar 

  20. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32:1358–66.

    Article  CAS  Google Scholar 

  21. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  Google Scholar 

  22. Diessl S, Holzberger B, Mader U, Grelle I, Smit JW, Buck AK, Reiners C, Verburg FA. Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin Endocrinol. 2012;76:586–92.

    Article  CAS  Google Scholar 

  23. Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy: effect on functioning metastases of adenocarcinoma of the thyroid. JAMA. 1946;132:838–47.

    Article  CAS  Google Scholar 

  24. Eskandari S, Loo DD, Dai G, Levy O, Wright EM, Carrasco N. Thyroid Na+/I- symporter. Mechanism, stoichiometry, and specificity. J Biol Chem. 1997;272:27230–8.

    Article  CAS  Google Scholar 

  25. Verburg FA, de Keizer B, Lips CJ, Zelissen PM, de Klerk JM. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol. 2005;152:33–7.

    Article  CAS  Google Scholar 

  26. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86:1447–63.

    Article  CAS  Google Scholar 

  27. Tubiana M, Schlumberger M, Rougier P, Laplanche A, Benhamou E, Gardet P, Caillou B, Travagli JP, Parmentier C. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer. 1985;55:794–804.

    Article  CAS  Google Scholar 

  28. Utiger RD. Follow-up of patients with thyroid carcinoma. N Engl J Med. 1997;337:928–30.

    Article  CAS  Google Scholar 

  29. Verburg FA, Dietlein M, Lassmann M, Luster M, Reiners C. Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2009;36:343–6.

    Article  Google Scholar 

  30. Sherman SI, Tielens ET, Sostre S, Wharam MD Jr, Ladenson PW. Clinical utility of posttreatment radioiodine scans in the management of patients with thyroid carcinoma. J Clin Endocrinol Metab. 1994;78:629–34.

    CAS  PubMed  Google Scholar 

  31. Tenenbaum F, Corone C, Schlumberger M, Parmentier C. Thyroglobulin measurement and postablative iodine-131 total body scan after total thyroidectomy for differentiated thyroid carcinoma in patients with no evidence of disease. Eur J Cancer. 1996;32A:1262.

    Article  CAS  Google Scholar 

  32. DeGroot LJ, Kaplan EL, Shukla MS, Salti G, Straus FH. Morbidity and mortality in follicular thyroid cancer. J Clin Endocrinol Metab. 1995;80:2946–53.

    CAS  PubMed  Google Scholar 

  33. Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, Ordonez NG. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75:714–20.

    CAS  PubMed  Google Scholar 

  34. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.

    Article  Google Scholar 

  35. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803.

    Article  CAS  Google Scholar 

  36. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, Tennvall J, Bombardieri E. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35:1941–59.

    Article  CAS  Google Scholar 

  37. Reiners C, Demidchik YE. Differentiated thyroid cancer in childhood: pathology, diagnosis, therapy. Pediatr Endocrinol Rev. 2003;1(Suppl 2):230–5.

    PubMed  Google Scholar 

  38. Reiners C, Biko J, Haenscheid H, Hebestreit H, Kirinjuk S, Baranowski O, Marlowe RJ, Demidchik E, Drozd V, Demidchik Y. Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very-high-risk radiation-induced differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2013;98:3039–48.

    Article  CAS  Google Scholar 

  39. Hanscheid H, Verburg FA, Biko J, Diessl S, Demidchik YE, Drozd V, Reiners C. Success of the postoperative 131I therapy in young Belarusian patients with differentiated thyroid cancer after Chernobyl depends on the radiation absorbed dose to the blood and the thyroglobulin level. Eur J Nucl Med Mol Imaging. 2011;38:1296–302.

    Article  Google Scholar 

  40. Luster M, Felbinger R, Dietlein M, Reiners C. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid. 2005;15:1147–55.

    Article  CAS  Google Scholar 

  41. Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid. 1997;7:613–9.

    Article  CAS  Google Scholar 

  42. Schroeder PR, Haugen BR, Pacini F, Reiners C, Schlumberger M, Sherman SI, Cooper DS, Schuff KG, Braverman LE, Skarulis MC, Davies TF, Mazzaferri EL, Daniels GH, Ross DS, Luster M, Samuels MH, Weintraub BD, Ridgway EC, Ladenson PW. A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab. 2006;91:878–84.

    Article  CAS  Google Scholar 

  43. Hanscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, Ladenson PW, Wahl RL, Schlumberger M, Ricard M, Driedger A, Kloos RT, Sherman SI, Haugen BR, Carriere V, Corone C, Reiners C. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med. 2006;47:654.

    Google Scholar 

  44. Rosario PW, Borges MA, Purisch S. Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotoxicity. J Nucl Med. 2008;49:1776–82.

    Article  Google Scholar 

  45. Frigo A, Dardano A, Danese E, Davi MV, Moghetti P, Colato C, Francia G, Bernardi F, Traino C, Monzani F, Ferdeghini M. Chromosome translocation frequency after radioiodine thyroid remnant ablation: a comparison between recombinant human thyrotropin stimulation and prolonged levothyroxine withdrawal. J Clin Endocrinol Metab. 2009;94:3472–6.

    Article  CAS  Google Scholar 

  46. Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI, Cooper DS, Graham KE, Braverman LE, Skarulis MC, Davies TF, DeGroot LJ, Mazzaferri EL, Daniels GH, Ross DS, Luster M, Samuels MH, Becker DV, Maxon HR III, Cavalieri RR, Spencer CA, McEllin K, Weintraub BD, Ridgway EC. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab. 1999;84:3877–85.

    CAS  Google Scholar 

  47. Borget I, Remy H, Chevalier J, Ricard M, Allyn M, Schlumberger M, De Pouvourville G. Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen. Eur J Nucl Med Mol Imaging. 2008;35:1457–63.

    Article  CAS  Google Scholar 

  48. Borget I, Corone C, Nocaudie M, Allyn M, Iacobelli S, Schlumberger M, De Pouvourville G. Sick leave for follow-up control in thyroid cancer patients: comparison between stimulation with Thyrogen and thyroid hormone withdrawal. Eur J Endocrinol. 2007;156:531–8.

    Article  CAS  Google Scholar 

  49. Bohuslavizki KH, Klutmann S, Jenicke L, Kroger S, Buchert R, Mester J, Clausen M. Salivary gland protection by S-2-(3-aminopropylamino)-ethylphosphorothioic acid (amifostine) in high-dose radioiodine treatment: results obtained in a rabbit animal model and in a double-blind multi-arm trial. Cancer Biother Radiopharm. 1999;14:337–47.

    Article  CAS  Google Scholar 

  50. Kim SJ, Choi HY, Kim IJ, Kim YK, Jun S, Nam HY, Kim JS. Limited cytoprotective effects of amifostine in high-dose radioactive iodine 131-treated well-differentiated thyroid cancer patients: analysis of quantitative salivary scan. Thyroid. 2008;18:325–31.

    Article  CAS  Google Scholar 

  51. Jentzen W, Schmitz J, Freudenberg L, Eising E, Hilbel T, Bockisch A, Stahl A. The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging. Eur J Nucl Med Mol Imaging. 2010;37:2298–306.

    Article  CAS  Google Scholar 

  52. Nakada K, Ishibashi T, Takei T, Hirata K, Shinohara K, Katoh S, Zhao S, Tamaki N, Noguchi Y, Noguchi S. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med. 2005;46:261–6.

    PubMed  Google Scholar 

  53. Solans R, Bosch JA, Galofre P, Porta F, Rosello J, Selva-O’Callagan A, Vilardell M. Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J Nucl Med. 2001;42:738–43.

    CAS  PubMed  Google Scholar 

  54. Seidlin SM, Siegal E, Yalow AA, Melamed S. Acute myeloid leukemia following prolonged iodine-131 therapy for metastatic thyroid carcinoma. Science. 1956;123:800–1.

    Article  CAS  Google Scholar 

  55. Sawka AM, Thabane L, Parlea L, Ibrahim-Zada I, Tsang RW, Brierley JD, Straus S, Ezzat S, Goldstein DP. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid. 2009;19:451–7.

    Article  CAS  Google Scholar 

  56. Verkooijen RB, Smit JW, Romijn JA, Stokkel MP. The incidence of second primary tumors in thyroid cancer patients is increased, but not related to treatment of thyroid cancer. Eur J Endocrinol. 2006;155:801–6.

    Article  CAS  Google Scholar 

  57. Benua RS, Cicale NR, Sonenberg M, Rawson RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. AJR. 1962;1962:171–82.

    Google Scholar 

  58. Molinaro E, Leboeuf R, Shue B, Martorella AJ, Fleisher M, Larson S, Tuttle RM. Mild decreases in white blood cell and platelet counts are present one year after radioactive iodine remnant ablation. Thyroid. 2009;19:1035–41.

    Article  Google Scholar 

  59. Verburg FA, Hanscheid H, Biko J, Hategan MC, Lassmann M, Kreissl MC, Reiners C, Luster M. Dosimetry-guided high-activity (131)I therapy in patients with advanced differentiated thyroid carcinoma: initial experience. Eur J Nucl Med Mol Imaging. 2010;37:896–903.

    Article  Google Scholar 

  60. Molenaar RJ, Sidana S, Radivoyevitch T, Advani AS, Gerds AT, Carraway HE, Angelini D, Kalaycio M, Nazha A, Adelstein DJ, Nasr C, Maciejewski JP, Majhail NS, Sekeres MA, Mukherjee S. Risk of hematologic malignancies after radioiodine treatment of well-differentiated thyroid cancer. J Clin Oncol. 2018;36:1831–9.

    Article  CAS  Google Scholar 

  61. Molenaar RJ, Pleyer C, Radivoyevitch T, Sidana S, Godley A, Advani AS, Gerds AT, Carraway HE, Kalaycio M, Nazha A, Adelstein DJ, Nasr C, Angelini D, Maciejewski JP, Majhail N, Sekeres MA, Mukherjee S. Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine. Leukemia. 2018;32:952–9.

    Article  CAS  Google Scholar 

  62. Piccardo A, Puntoni M, Verburg FA, Luster M, Giovanella L. Power of absolute values to avoid data misinterpretations: the case of radioiodine-induced leukemia and myelodysplasia. J Clin Oncol. 2018;36:1880–1.

    Article  Google Scholar 

  63. Ain KB. Radioiodine-remnant ablation in low-risk differentiated thyroid cancer: pros. Endocrine. 2015;50:61–6.

    Article  CAS  Google Scholar 

  64. Rosario PW, Barroso AL, Rezende LL, Padrao EL, Borges MA, Guimaraes VC, Purisch S. Testicular function after radioiodine therapy in patients with thyroid cancer. Thyroid. 2006;16:667–70.

    Article  CAS  Google Scholar 

  65. Sawka AM, Lakra DC, Lea J, Alshehri B, Tsang RW, Brierley JD, Straus S, Thabane L, Gafni A, Ezzat S, George SR, Goldstein DP. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol. 2008;69:479–90.

    Article  Google Scholar 

  66. Hebestreit H, Biko J, Drozd V, Demidchik Y, Burkhardt A, Trusen A, Beer M, Reiners C. Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl. Eur J Nucl Med Mol Imaging. 2011;38:1683–90.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Frederik A. Verburg .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Verburg, F.A. (2019). Radioiodine Therapy of Thyroid Cancer. In: Giovanella, L. (eds) Nuclear Medicine Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-17494-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17494-1_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17493-4

  • Online ISBN: 978-3-030-17494-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics