Challenges and strategies on radioiodine treatment for differentiated thyroid carcinoma

Objective: Radioiodine (I-131) is considered an effective and low-risk therapeutic radionuclide for differentiated thyroid carcinoma (DTC); however, dilemmas exist in the optimization of indications, pre-treatment thyroid stimulating hormone (TSH) stimulation, dose decision, as well as in the treatment of I-131-refractory disease. Refined strategies on I-131 treatment for DTC based on late evidence and novel insights are greatly needed. Conclusion: The indications of I-131 ablation continue to be refined with a better understanding of the risks and benefits. For pre-treatment TSH stimulation, recombinant human thyrotropin presents a better choice as it improves the quality of life, but is indicated only for ablation of the thyroid remnant and follow-up. Decreased doses of I-131 seem to be more appropriate in patients without gross residual disease or metastases, but maximal doses are suggested in patients with advanced disease. Imaging procedures contributing to decision-making for patients with advanced DTC also continue to be modified. As for the I-131-refractory disease, there is a trend to increase I-131 uptake and retention by using additional therapeutic agents like kinase inhibitors with encouraging results.