Guidelines for radioiodine therapy in differentiated thyroid cancer and post-therapeutic follow-up

The radioiodine therapy is a one of the basic elements at combined treatment of differentiated thyroid cancer and is an alternative method for patients with distant metastases and a potentially high risk of tumor recurrence. It has been used in clinical practice for more than 80 years. The first report on the phenomenon of accumulation of ¹³⁰I/¹³¹I in a metastatic focus of differentiated thyroid cancer was published by A. Keston et al. in 1942, and in 1946, the production of ¹³¹I was established, and the drug became available. In our country, radioiodine therapy has been widely used for the treatment of differentiated thyroid cancer since 1982.

This article presents methodological recommendations for radioiodine therapy of patients with differentiated thyroid cancer, provides a modern examination algorithm, discusses the basic principles of laboratory, instrumental diagnostics and treatment approaches treatment of this disease.

1. Choinzonov E.L., Reshetov I.V., Ivanov S.A. et al. Draft clinical guidelines for the diagnosis and treatment of differentiated thyroid cancer in adult patients. Endokrinnaya khirurgiya = Endocrine Surgery 2022;16(2):5-29. (In Russ.). DOI: 10.14341/serg12792

2. Shishkina V.V., Chebotareva E.D., Semichev D.S. Therapeutic use of open radionuclides. Kiev, 1988. Pp. 4—10. (In Russ.).

3. Filetti S., Bidart J., Arturi F. et al. Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism. Eur J Endocrinol 1999;141(5):443-57. DOI: 10.1530/eje.0.1410443

4. Bogolyubova A.V., Abrosimov A.Yu., Selivanova L.S., Belousov P.V. Histological and molecular genetic characteristics of clinically aggressive variants of papillary thyroid cancer. Arkhiv patologii = Pathology Archive 2019;81(1):46-51. (In Russ.). DOI: 10.17116/patol20198101146

5. Tuttle R., Ahuja S., Avram A. et al. Controversies, consensus, and collaboration in the use of 131I therapy in differentiated thyroid cancer: a joint statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association. Thyroid 2019;29(4):461-70. DOI: 10.1089/thy.2018.0597

6. Shaha A. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope 2004;114(3):393-402. DOI: 10.1097/00005537-200403000-00001

7. Haugen B., Alexander E., Bible Keith C. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26(1):1-133. DOI: 10.1089/thy.2015.0020

8. Kaprin A.D., Mardynskiy Yu.S. The Therapeutic radiology. Moscow: GEOTAR Media, 2018. (In Russ.).

9. Cooper D., Doherty G., Haugen B. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16(2):109-42. DOI: 10.1089/thy.2006.16.109

10. Sawka A., 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(10):1129-38. DOI: 10.1089/thy.2010.0055

11. Maxon H., Thomas S., Boehringer A. et al. Low iodine diet in I-131 ablation of thyroid remnants. Clin Nucl Med 1983;8(3):123-6. DOI: 10.1097/00003072-198303000-00006

12. Shankar L.K., Yamamoto A.J., Alavi A., Mandel S.J. Comparison of 123I scintigraphy at 5 and 24 hours in patients with differentiated thyroid cancer. J Nucl Med 2002;43(1):72-6.

13. Sanitary rules and regulations (SanPiN) 2.6.1.2368-08. “Hygienic requirements for ensuring radiation safety during radiation therapy using open radionuclide sources” (approved by Resolution No. 36 of the Chief State Sanitary Doctor of the Russian Federation dated 16 June 2008). (In Russ.).

14. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Thyroid Carcinoma. Version 2.2022.

15. Filetti S., Durante C., Hartl D. et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019;30(12):1856-83. DOI: 10.1093/annonc/mdz400

16. Dewaraja Y.K., Ljungberg M., Green A.J. et al. MIRD pamphlet No. 24: Guidelines for quantitative 131I SPECT in dosimetry applications. J Nucl Med 2013;54(12):2182-8. DOI: 10.2967/jnumed.113.122390

17. Van Nostrand D. Sialoadenitis secondary to 131I therapy for well- differentiated thyroid cancer. Oral Dis 2011;17(2):154-61. DOI: 10.1111/j.1601-0825.2010.01726.x

18. Burns J., Morgenstern K., Cahill K. et al. Nasolacrimal duct obstruction secondary to I131 therapy. Ophthal Plast Reconstr Surg 2004;20(2):126-9. DOI: 10.1097/01.iop.0000117340.41849.81

19. Wu J.X., Young S., Ro K. et al. Reproductive outcomes and nononcologic complications after radioactive iodine ablation for well-differentiated thyroid cancer. Thyroid 2015;25(1):133-8. DOI: 10.1089/thy.2014.0343

20. Pacini F., Gasperi M., Fugazzola L. et al. Testicular function in patients with differentiated thyroid carcinoma treated with radioiodine. J Nucl Med 1994;35(9):1418-22.

21. Wichers M., Benz E., Palmedo H. et al. Testicular function after radioiodine therapy for thyroid cancer. Eur J Nucl Med 2000;27(5):503-7. DOI: 10.1007/s002590050535

22. Handelsman D.J., Conway A.J., Donnelly P.E., Turtle J.R. Azoospermia after iodine-131 treatment for thyroid carcinoma. Br Med J 1980;281(6254):1527. DOI: 10.1136/bmj.281.6254.1527

23. Klimanov V.A. Nuclear medicine. Radionuclide diagnostics: a textbook for universities. 2nd edn., ispr. and add. Moscow: Yurai, 2022. (In Russ.).

24. Shurinov A.Yu., Borodavina E.V. Follow-up after radioiodine remnant ablation in differentiated thyroid cancer: the view of nuclear medicine physician. Opukholi golovy i shei = Head and Neck Tumors 2023;13(1):91-101. (In Russ.). DOI: 10.17650/2222-1468-2023-13-1-91-101

25. Haugen B.R., Alexander E.K., Bible K.C. 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):1-133. DOI: 10.1089/thy.2015.0020