Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Differentiated thyroid cancer: Radioiodine treatment

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


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".)


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:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jul 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Spitzweg C, Harrington KJ, Pinke LA, et al. Clinical review 132: The sodium iodide symporter and its potential role in cancer therapy. J Clin Endocrinol Metab 2001; 86:3327.
  2. Haugen BR, Alexander EK, Bible KC, et al. 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.
  3. Sawka AM, Brierley JD, Tsang RW, et al. An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer. Endocrinol Metab Clin North Am 2008; 37:457.
  4. Sacks W, Fung CH, Chang JT, et al. The effectiveness of radioactive iodine for treatment of low-risk thyroid cancer: a systematic analysis of the peer-reviewed literature from 1966 to April 2008. Thyroid 2010; 20:1235.
  5. Lamartina L, Durante C, Filetti S, Cooper DS. Low-risk differentiated thyroid cancer and radioiodine remnant ablation: a systematic review of the literature. J Clin Endocrinol Metab 2015; 100:1748.
  6. Nixon IJ, Ganly I, Patel SG, et al. The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification. Thyroid 2013; 23:683.
  7. Kim HJ, Kim NK, Choi JH, et al. Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma. Clin Endocrinol (Oxf) 2013; 78:614.
  8. Ruel E, Thomas S, Dinan M, et al. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab 2015; 100:1529.
  9. Carhill AA, Litofsky DR, Ross DS, et al. Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012. J Clin Endocrinol Metab 2015; 100:3270.
  10. Podnos YD, Smith DD, Wagman LD, Ellenhorn JD. Survival in patients with papillary thyroid cancer is not affected by the use of radioactive isotope. J Surg Oncol 2007; 96:3.
  11. Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006; 91:2892.
  12. American Thyroid Association Taskforce On Radioiodine Safety, Sisson JC, Freitas J, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid 2011; 21:335.
  13. Brzozowska M, Roach PJ. Timing and potential role of diagnostic I-123 scintigraphy in assessing radioiodine breast uptake before ablation in postpartum women with thyroid cancer: a case series. Clin Nucl Med 2006; 31:683.
  14. Pacini F, Molinaro E, Castagna MG, et al. Ablation of thyroid residues with 30 mCi (131)I: a comparison in thyroid cancer patients prepared with recombinant human TSH or thyroid hormone withdrawal. J Clin Endocrinol Metab 2002; 87:4063.
  15. Chianelli M, Todino V, Graziano FM, et al. Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients. Eur J Endocrinol 2009; 160:431.
  16. Lee J, Yun MJ, Nam KH, et al. Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid 2010; 20:173.
  17. Pacini F, Ladenson PW, Schlumberger M, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab 2006; 91:926.
  18. Tu J, Wang S, Huo Z, et al. Recombinant human thyrotropin-aided versus thyroid hormone withdrawal-aided radioiodine treatment for differentiated thyroid cancer after total thyroidectomy: a meta-analysis. Radiother Oncol 2014; 110:25.
  19. Schlumberger M, Catargi B, Borget I, et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 2012; 366:1663.
  20. Mallick U, Harmer C, Yap B, et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 2012; 366:1674.
  21. Pak K, Cheon GJ, Kang KW, et al. The effectiveness of recombinant human thyroid-stimulating hormone versus thyroid hormone withdrawal prior to radioiodine remnant ablation in thyroid cancer: a meta-analysis of randomized controlled trials. J Korean Med Sci 2014; 29:811.
  22. Molinaro E, Giani C, Agate L, et al. Patients with differentiated thyroid cancer who underwent radioiodine thyroid remnant ablation with low-activity ¹³¹I after either recombinant human TSH or thyroid hormone therapy withdrawal showed the same outcome after a 10-year follow-up. J Clin Endocrinol Metab 2013; 98:2693.
  23. Hugo J, Robenshtok E, Grewal R, et al. Recombinant human thyroid stimulating hormone-assisted radioactive iodine remnant ablation in thyroid cancer patients at intermediate to high risk of recurrence. Thyroid 2012; 22:1007.
  24. Tuttle RM, Lopez N, Leboeuf R, et al. Radioactive iodine administered for thyroid remnant ablation following recombinant human thyroid stimulating hormone preparation also has an important adjuvant therapy function. Thyroid 2010; 20:257.
  25. Tala H, Robbins R, Fagin JA, et al. Five-year survival is similar in thyroid cancer patients with distant metastases prepared for radioactive iodine therapy with either thyroid hormone withdrawal or recombinant human TSH. J Clin Endocrinol Metab 2011; 96:2105.
  26. Schlumberger M, Tubiana M, De Vathaire F, et al. Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J Clin Endocrinol Metab 1986; 63:960.
  27. Guimaraes V, DeGroot LJ. Moderate hypothyroidism in preparation for whole body 131I scintiscans and thyroglobulin testing. Thyroid 1996; 6:69.
  28. Goldman JM, Line BR, Aamodt RL, Robbins J. Influence of triiodothyronine withdrawal time on 131I uptake postthyroidectomy for thyroid cancer. J Clin Endocrinol Metab 1980; 50:734.
  29. Leboeuf R, Perron P, Carpentier AC, et al. L-T3 preparation for whole-body scintigraphy: a randomized-controlled trial. Clin Endocrinol (Oxf) 2007; 67:839.
  30. Braga M, Ringel MD, Cooper DS. Sudden enlargement of local recurrent thyroid tumor after recombinant human TSH administration. J Clin Endocrinol Metab 2001; 86:5148.
  31. Biondi B, Palmieri EA, Pagano L, et al. Cardiovascular safety of acute recombinant human thyrotropin administration to patients monitored for differentiated thyroid cancer. J Clin Endocrinol Metab 2003; 88:211.
  32. Park JT 2nd, Hennessey JV. Two-week low iodine diet is necessary for adequate outpatient preparation for radioiodine rhTSH scanning in patients taking levothyroxine. Thyroid 2004; 14:57.
  33. Lee M, Lee YK, Jeon TJ, et al. Low iodine diet for one week is sufficient for adequate preparation of high dose radioactive iodine ablation therapy of differentiated thyroid cancer patients in iodine-rich areas. Thyroid 2014; 24:1289.
  34. Li JH, He ZH, Bansal V, Hennessey JV. Low iodine diet in differentiated thyroid cancer: a review. Clin Endocrinol (Oxf) 2016; 84:3.
  35. Sawka AM, Ibrahim-Zada I, Galacgac P, et al. Dietary iodine restriction in preparation for radioactive iodine treatment or scanning in well-differentiated thyroid cancer: a systematic review. Thyroid 2010; 20:1129.
  36. Pluijmen MJ, Eustatia-Rutten C, Goslings BM, et al. Effects of low-iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2003; 58:428.
  37. Tala Jury HP, Castagna MG, Fioravanti C, et al. Lack of association between urinary iodine excretion and successful thyroid ablation in thyroid cancer patients. J Clin Endocrinol Metab 2010; 95:230.
  38. Sohn SY, Choi JY, Jang HW, et al. Association between excessive urinary iodine excretion and failure of radioactive iodine thyroid ablation in patients with papillary thyroid cancer. Thyroid 2013; 23:741.
  39. Padovani RP, Kasamatsu TS, Nakabashi CC, et al. One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy. Thyroid 2012; 22:926.
  40. Toubert ME, Dib-Deperrest A, Houzé P, et al. Plasma exchanges overcome persistent iodine overload to enable 131I ablation of differentiated thyroid carcinoma. Thyroid 2008; 18:469.
  41. Matovic MD, Jankovic SM, Jeremic M, et al. Unexpected effect of furosemide on radioiodine urinary excretion in patients with differentiated thyroid carcinomas treated with iodine 131. Thyroid 2009; 19:843.
  42. Koong SS, Reynolds JC, Movius EG, et al. Lithium as a potential adjuvant to 131I therapy of metastatic, well differentiated thyroid carcinoma. J Clin Endocrinol Metab 1999; 84:912.
  43. Ho AL, Grewal RK, Leboeuf R, et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med 2013; 368:623.
  44. Rothenberg SM, McFadden DG, Palmer EL, et al. Redifferentiation of iodine-refractory BRAF V600E-mutant metastatic papillary thyroid cancer with dabrafenib. Clin Cancer Res 2015; 21:1028.
  45. Salvatori M, Perotti G, Rufini V, et al. Are there disadvantages in administering 131I ablation therapy in patients with differentiated thyroid carcinoma without a preablative diagnostic 131I whole-body scan? Clin Endocrinol (Oxf) 2004; 61:704.
  46. Van Nostrand D, Aiken M, Atkins F, et al. The utility of radioiodine scans prior to iodine 131 ablation in patients with well-differentiated thyroid cancer. Thyroid 2009; 19:849.
  47. Maxon HR 3rd, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am 1990; 19:685.
  48. Nĕmec J, Röhling S, Zamrazil V, Pohunková D. Comparison of the distribution of diagnostic and thyroablative I-131 in the evaluation of differentiated thyroid cancers. J Nucl Med 1979; 20:92.
  49. Waxman A, Ramanna L, Chapman N, et al. The significance of 1-131 scan dose in patients with thyroid cancer: determination of ablation: concise communication. J Nucl Med 1981; 22:861.
  50. Park HM. Stunned thyroid after high-dose I-131 imaging. Clin Nucl Med 1992; 17:501.
  51. Sherman SI, Tielens ET, Sostre S, et al. Clinical utility of posttreatment radioiodine scans in the management of patients with thyroid carcinoma. J Clin Endocrinol Metab 1994; 78:629.
  52. Lundh C, Nordén MM, Nilsson M, Forssell-Aronsson E. Reduced iodide transport (stunning) and DNA synthesis in thyrocytes exposed to low absorbed doses from 131I in vitro. J Nucl Med 2007; 48:481.
  53. Nordén MM, Larsson F, Tedelind S, et al. Down-regulation of the sodium/iodide symporter explains 131I-induced thyroid stunning. Cancer Res 2007; 67:7512.
  54. Morris LF, Waxman AD, Braunstein GD. The nonimpact of thyroid stunning: remnant ablation rates in 131I-scanned and nonscanned individuals. J Clin Endocrinol Metab 2001; 86:3507.
  55. Silberstein EB. Comparison of outcomes after (123)I versus (131)I pre-ablation imaging before radioiodine ablation in differentiated thyroid carcinoma. J Nucl Med 2007; 48:1043.
  56. Hilditch TE, Dempsey MF, Bolster AA, et al. Self-stunning in thyroid ablation: evidence from comparative studies of diagnostic 131I and 123I. Eur J Nucl Med Mol Imaging 2002; 29:783.
  57. Maxon HR 3rd, Englaro EE, Thomas SR, et al. Radioiodine-131 therapy for well-differentiated thyroid cancer--a quantitative radiation dosimetric approach: outcome and validation in 85 patients. J Nucl Med 1992; 33:1132.
  58. Tuttle RM, Brokhin M, Omry G, et al. Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med 2008; 49:764.
  59. Chen L, Luo Q, Shen Y, et al. Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma. J Nucl Med 2008; 49:1952.
  60. Wong KK, Zarzhevsky N, Cahill JM, et al. Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol 2008; 191:1785.
  61. Grewal RK, Tuttle RM, Fox J, et al. The effect of posttherapy 131I SPECT/CT on risk classification and management of patients with differentiated thyroid cancer. J Nucl Med 2010; 51:1361.
  62. Mandel SJ, Shankar LK, Benard F, et al. Superiority of iodine-123 compared with iodine-131 scanning for thyroid remnants in patients with differentiated thyroid cancer. Clin Nucl Med 2001; 26:6.
  63. Siddiqi A, Foley RR, Britton KE, et al. The role of 123I-diagnostic imaging in the follow-up of patients with differentiated thyroid carcinoma as compared to 131I-scanning: avoidance of negative therapeutic uptake due to stunning. Clin Endocrinol (Oxf) 2001; 55:515.
  64. Salvatori M, Raffaelli M, Castaldi P, et al. Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 2007; 33:648.
  65. Zeuren R, Biagini A, Grewal RK, et al. RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system. Laryngoscope 2015; 125:2417.
  66. Simpson WJ, Panzarella T, Carruthers JS, et al. Papillary and follicular thyroid cancer: impact of treatment in 1578 patients. Int J Radiat Oncol Biol Phys 1988; 14:1063.
  67. Wilson LM, Barrington SF, Morrison ID, et al. Therapeutic implications of thymic uptake of radioiodine in thyroid carcinoma. Eur J Nucl Med 1998; 25:622.
  68. You DL, Tzen KY, Chen JF, et al. False-positive whole-body iodine-131 scan due to intrahepatic duct dilatation. J Nucl Med 1997; 38:1977.
  69. Rudoni S, Toubeau M, Mansuy S, et al. [False positive scintigraphic images in the surveillance of differentiated thyroid cancers]. Ann Endocrinol (Paris) 1997; 58:399.
  70. 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.
  71. Hackshaw A, Harmer C, Mallick U, et al. 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. J Clin Endocrinol Metab 2007; 92:28.
  72. Pilli T, Brianzoni E, Capoccetti F, et al. A comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-iodine administered doses for recombinant thyrotropin-stimulated postoperative thyroid remnant ablation in differentiated thyroid cancer. J Clin Endocrinol Metab 2007; 92:3542.
  73. Rosário PW, Borges MA, Valadão MM, et al. Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm? Thyroid 2007; 17:1225.
  74. Cheng W, Ma C, Fu H, et al. Low- or high-dose radioiodine remnant ablation for differentiated thyroid carcinoma: a meta-analysis. J Clin Endocrinol Metab 2013; 98:1353.
  75. Valachis A, Nearchou A. High versus low radioiodine activity in patients with differentiated thyroid cancer: a meta-analysis. Acta Oncol 2013; 52:1055.
  76. Ma C, Tang L, Fu H, et al. rhTSH-aided low-activity versus high-activity regimens of radioiodine in residual ablation for differentiated thyroid cancer: a meta-analysis. Nucl Med Commun 2013; 34:1150.
  77. Fang Y, Ding Y, Guo Q, et al. Radioiodine therapy for patients with differentiated thyroid cancer after thyroidectomy: direct comparison and network meta-analyses. J Endocrinol Invest 2013; 36:896.
  78. Mazzaferri EL. Thyroid remnant 131I ablation for papillary and follicular thyroid carcinoma. Thyroid 1997; 7:265.
  79. Rosário PW, Purisch S, Vasconcelos FP, et al. Long-term recurrence of thyroid cancer after thyroid remnant ablation with 1.1 and 3.7 GBq radioiodine. Nucl Med Commun 2007; 28:507.
  80. Han JM, Kim WG, Kim TY, et al. Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension. Thyroid 2014; 24:820.
  81. Castagna MG, Cevenini G, Theodoropoulou A, et al. Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients. Eur J Endocrinol 2013; 169:23.
  82. Sabra MM, Grewal RK, Ghossein RA, Tuttle RM. Higher administered activities of radioactive iodine are associated with less structural persistent response in older, but not younger, papillary thyroid cancer patients with lateral neck lymph node metastases. Thyroid 2014; 24:1088.
  83. Verburg FA, Mäder U, Reiners C, Hänscheid H. Long-term survival in differentiated thyroid cancer is worse after low-activity initial post-surgical 131I therapy in both high- and low-risk patients. J Clin Endocrinol Metab 2014; 99:4487.
  84. Tuttle RM, Leboeuf R, Robbins RJ, et al. Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med 2006; 47:1587.
  85. Kulkarni K, Van Nostrand D, Atkins F, et al. The relative frequency in which empiric dosages of radioiodine would potentially overtreat or undertreat patients who have metastatic well-differentiated thyroid cancer. Thyroid 2006; 16:1019.
  86. BENUA RS, CICALE NR, SONENBERG M, RAWSON RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. Am J Roentgenol Radium Ther Nucl Med 1962; 87:171.
  87. Holst JP, Burman KD, Atkins F, et al. Radioiodine therapy for thyroid cancer and hyperthyroidism in patients with end-stage renal disease on hemodialysis. Thyroid 2005; 15:1321.
  88. Murcutt G, Edwards J, Boakye J, Davenport A. Hemodialysis of chronic kidney failure patients requiring ablative radioiodine therapy. Kidney Int 2008; 73:1316.
  89. Fatourechi V, Hay ID, Mullan BP, et al. Are posttherapy radioiodine scans informative and do they influence subsequent therapy of patients with differentiated thyroid cancer? Thyroid 2000; 10:573.
  90. Souza Rosário PW, Barroso AL, Rezende LL, et al. Post I-131 therapy scanning in patients with thyroid carcinoma metastases: an unnecessary cost or a relevant contribution? Clin Nucl Med 2004; 29:795.
  91. Alzahrani AS, Bakheet S, Al Mandil M, et al. 123I isotope as a diagnostic agent in the follow-up of patients with differentiated thyroid cancer: comparison with post 131I therapy whole body scanning. J Clin Endocrinol Metab 2001; 86:5294.
  92. Grigsby PW, Baglan K, Siegel BA. Surveillance of patients to detect recurrent thyroid carcinoma. Cancer 1999; 85:945.
  93. Basaria M, Graf H, Cooper DS. The use of recombinant thyrotropin in the follow-up of patients with differentiated thyroid cancer. Am J Med 2002; 112:721.
  94. Lee SL. Complications of radioactive iodine treatment of thyroid carcinoma. J Natl Compr Canc Netw 2010; 8:1277.
  95. Mandel SJ, Mandel L. Radioactive iodine and the salivary glands. Thyroid 2003; 13:265.
  96. Malpani BL, Samuel AM, Ray S. Quantification of salivary gland function in thyroid cancer patients treated with radioiodine. Int J Radiat Oncol Biol Phys 1996; 35:535.
  97. Nakada K, Ishibashi T, Takei T, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med 2005; 46:261.
  98. Jentzen W, Balschuweit D, Schmitz J, et al. 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.
  99. Van Nostrand D, Bandaru V, Chennupati S, et al. Radiopharmacokinetics of radioiodine in the parotid glands after the administration of lemon juice. Thyroid 2010; 20:1113.
  100. Walter MA, Turtschi CP, Schindler C, et al. The dental safety profile of high-dose radioiodine therapy for thyroid cancer: long-term results of a longitudinal cohort study. J Nucl Med 2007; 48:1620.
  101. Bohuslavizki KH, Klutmann S, Jenicke L, et al. 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.
  102. Mendoza A, Shaffer B, Karakla D, et al. Quality of life with well-differentiated thyroid cancer: treatment toxicities and their reduction. Thyroid 2004; 14:133.
  103. Zoberi I, Wasserman TH, Chao KS. A prospective, nonrandomized study of the impact of amifostine on subsequent hypothyroidism in irradiated patients with head and neck cancers. Semin Radiat Oncol 2002; 12:14.
  104. Lang BH, Wong IO, Wong KP, et al. Risk of second primary malignancy in differentiated thyroid carcinoma treated with radioactive iodine therapy. Surgery 2012; 151:844.
  105. Sawka AM, Thabane L, Parlea L, et al. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 2009; 19:451.
  106. Chen AY, Levy L, Goepfert H, et al. The development of breast carcinoma in women with thyroid carcinoma. Cancer 2001; 92:225.
  107. Li CI, Rossing MA, Voigt LF, Daling JR. Multiple primary breast and thyroid cancers: role of age at diagnosis and cancer treatments (United States). Cancer Causes Control 2000; 11:805.
  108. Adjadj E, Rubino C, Shamsaldim A, et al. The risk of multiple primary breast and thyroid carcinomas. Cancer 2003; 98:1309.
  109. Hall P, Holm LE, Lundell G, et al. Cancer risks in thyroid cancer patients. Br J Cancer 1991; 64:159.
  110. de Vathaire F, Schlumberger M, Delisle MJ, et al. Leukaemias and cancers following iodine-131 administration for thyroid cancer. Br J Cancer 1997; 75:734.
  111. Seo GH, Cho YY, Chung JH, Kim SW. Increased Risk of Leukemia After Radioactive Iodine Therapy in Patients with Thyroid Cancer: A Nationwide, Population-Based Study in Korea. Thyroid 2015; 25:927.
  112. Rubino C, de Vathaire F, Dottorini ME, et al. Second primary malignancies in thyroid cancer patients. Br J Cancer 2003; 89:1638.
  113. Ahn HY, Min HS, Yeo Y, et al. Radioactive Iodine Therapy Did Not Significantly Increase the Incidence and Recurrence of Subsequent Breast Cancer. J Clin Endocrinol Metab 2015; 100:3486.
  114. Brown AP, Chen J, Hitchcock YJ, et al. The risk of second primary malignancies up to three decades after the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab 2008; 93:504.
  115. Iyer NG, Morris LG, Tuttle RM, et al. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer 2011; 117:4439.
  116. Frigo A, Dardano A, Danese E, et al. 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.
  117. Hyer S, Vini L, O'Connell M, et al. Testicular dose and fertility in men following I(131) therapy for thyroid cancer. Clin Endocrinol (Oxf) 2002; 56:755.
  118. Rosário PW, Barroso AL, Rezende LL, et al. Testicular function after radioiodine therapy in patients with thyroid cancer. Thyroid 2006; 16:667.
  119. Ceccarelli C, Bencivelli W, Morciano D, et al. 131I therapy for differentiated thyroid cancer leads to an earlier onset of menopause: results of a retrospective study. J Clin Endocrinol Metab 2001; 86:3512.
  120. Sawka AM, Lea J, Alshehri B, et al. A systematic review of the gonadal effects of therapeutic radioactive iodine in male thyroid cancer survivors. Clin Endocrinol (Oxf) 2008; 68:610.
  121. Sawka AM, Lakra DC, Lea J, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf) 2008; 69:479.
  122. Lin JD, Wang HS, Weng HF, Kao PF. Outcome of pregnancy after radioactive iodine treatment for well differentiated thyroid carcinomas. J Endocrinol Invest 1998; 21:662.
  123. Bal C, Kumar A, Tripathi M, et al. High-dose radioiodine treatment for differentiated thyroid carcinoma is not associated with change in female fertility or any genetic risk to the offspring. Int J Radiat Oncol Biol Phys 2005; 63:449.
  124. Garsi JP, Schlumberger M, Rubino C, et al. Therapeutic administration of 131I for differentiated thyroid cancer: radiation dose to ovaries and outcome of pregnancies. J Nucl Med 2008; 49:845.
  125. Kloos RT, Duvuuri V, Jhiang SM, et al. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab 2002; 87:5817.
  126. Shepler TR, Sherman SI, Faustina MM, et al. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthal Plast Reconstr Surg 2003; 19:479.
  127. Luster M, Lippi F, Jarzab B, et al. rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review. Endocr Relat Cancer 2005; 12:49.
  128. http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/sr1556v9r2-final.pdf#08-33 (Accessed on April 22, 2011).
  129. http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/sr1556v9r2-final.pdf#08-36 (Accessed on April 22, 2011).
  130. United States Nuclear Regulatory Commission (NRC). Consolidated Guidance About Materials Licenses: Program-Specific Guidance About Medical Use Licenses, 2008. http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/sr1556v9r2-final.pdf#08-36 (Accessed on May 06, 2011).
  131. Grigsby PW, Siegel BA, Baker S, Eichling JO. Radiation exposure from outpatient radioactive iodine (131I) therapy for thyroid carcinoma. JAMA 2000; 283:2272.