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Radioiodine Therapy – Thyroid Treatment Explained

Radioiodine therapy is a nuclear medicine treatment using radioactive iodine (iodine-131) to treat thyroid disorders such as hyperthyroidism and thyroid cancer.

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Things worth knowing about "Radioiodine Therapy"

Radioiodine therapy is a nuclear medicine treatment using radioactive iodine (iodine-131) to treat thyroid disorders such as hyperthyroidism and thyroid cancer.

What is Radioiodine Therapy?

Radioiodine therapy (also called radioactive iodine therapy or RAI therapy) is a nuclear medicine procedure in which radioactive iodine (iodine-131, or I-131) is used to selectively destroy or reduce thyroid tissue. Because the thyroid gland absorbs nearly all available iodine in the body, the radiation acts in a highly targeted manner on the affected tissue while largely sparing surrounding structures.

Indications

Radioiodine therapy is used to treat several thyroid conditions, including:

Hyperthyroidism (overactive thyroid): for example, in Graves disease or autonomous thyroid nodules
Differentiated thyroid cancer: to ablate residual thyroid tissue after surgical removal of the thyroid gland
Goiter (enlarged thyroid): to reduce the size of an enlarged thyroid gland

Mechanism of Action

After oral administration (capsule or liquid solution), iodine-131 is taken up by thyroid cells. I-131 is a radionuclide that emits both beta and gamma radiation. The beta radiation has a very short range (a few millimeters) and destroys thyroid tissue from within. The gamma radiation additionally enables imaging for therapy monitoring.

Treatment Process

Preparation

Before therapy, a radioiodine uptake test is typically performed to calculate the optimal I-131 dose. Patients are required to follow a low-iodine diet for several weeks and to discontinue antithyroid medications (thionamides) so that the thyroid can absorb the radioactive iodine as effectively as possible.

Administration

The therapy is usually carried out on an inpatient basis at a nuclear medicine facility. The radioactive iodine is taken as a capsule or liquid solution. Due to radiation protection regulations, patients must remain in isolation for several days until their radiation levels have dropped to a safe level.

Follow-up Care

After treatment, regular follow-up examinations are necessary. In many patients, radioiodine therapy results in hypothyroidism (underactive thyroid), which requires lifelong treatment with thyroid hormone replacement (levothyroxine).

Side Effects and Risks

Inflammation of the salivary glands (sialadenitis) with dry mouth and discomfort
Temporary worsening of existing hyperthyroidism
Development of permanent hypothyroidism (often the desired outcome)
Minor radiation exposure to adjacent tissues
Rarely: worsening of thyroid eye disease (Graves orbitopathy) in patients with Graves disease

Contraindications

Radioiodine therapy is not suitable for:

Pregnant and breastfeeding women (absolute contraindication)
Children and adolescents (relative contraindication, only in exceptional cases)
Patients with significantly reduced thyroid iodine uptake

Advantages of Radioiodine Therapy

Compared to surgery, radioiodine therapy is a minimally invasive procedure that carries no anesthetic risk and avoids surgical complications such as vocal cord paralysis or damage to the parathyroid glands. The therapy is highly effective and has been used successfully for decades.

References

Deutsche Gesellschaft für Nuklearmedizin (DGN) - Guidelines on Radioiodine Therapy, 2022. Available at: www.nuklearmedizin.de
Reiners C. et al. - Radioiodine Therapy of the Thyroid Gland. Nuklearmedizin, Schattauer Verlag, 2018.
Haugen BR et al. - 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.

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