Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for I-131 whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative (131) I therapy is given for all differentiated thyroid carcinoma (DTC) > I cm. Regarding DTC <= l cm (131) I ablation may be helpful in an individual constellation. Preparation for I-131 ablation requires low iodine diet for two weeks and TSH-stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSH-stimulation (necessary for (131)1-therapy in patients with metastases, higher sensitivity Of 1311 whole-body scan) are discussed. In most centers standard activities are used for 1311 ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of (131) I should not exceed 1 -10 MBq, alternative tracers are 1111 or I'll. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene.