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Differentiated thyroid cancer: Radioiodine treatment

Author
R Michael Tuttle, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Radioiodine therapy has been used in the management of patients with well-differentiated (papillary or follicular) thyroid cancer since the 1940s. Thyroid tissue has a unique ability to take up iodine from blood. Like iodine, radioiodine is taken up and concentrated in thyroid follicular cells because they have a membrane sodium-iodide transporter [1]. Compared with normal thyroid follicular cells, thyroid cancer cells have reduced expression of the transporter, which may account for the low iodine-131 (131-I) uptake in thyroid cancer tissue.

131-I causes acute thyroid-cell death by emission of short path-length (1 to 2 mm) beta particles. The uptake of 131-I by thyroid tissue can be visualized by scanning to detect the gamma radiation that is also emitted by the isotope. 131-I must be taken up by thyroid tissue to be effective. As a result, it is of no value in patients whose thyroid cancers do not concentrate iodide, for example patients with medullary cancer, lymphoma, or anaplastic cancer.

Radioiodine therapy for differentiated thyroid cancer will be reviewed here. Surgery, the primary therapy for differentiated thyroid cancer, and an overview of the management of thyroid cancer are discussed separately. (See "Differentiated thyroid cancer: Surgical treatment" and "Differentiated thyroid cancer: Overview of management".)

GOALS

Radioiodine is administered after thyroidectomy in patients with differentiated thyroid cancer to ablate residual normal thyroid tissue (remnant ablation), to provide adjuvant therapy of subclinical micrometastatic disease, and/or to provide treatment of clinically apparent residual or metastatic thyroid cancer.

Residual normal thyroid tissue – The rationale for treatment of residual normal thyroid tissue with iodine-131 (131-I) is to destroy any remnant normal thyroid tissue remaining after total thyroidectomy (remnant ablation). This will, in turn:

                                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 21 00:00:00 GMT+00:00 2016.
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