The benefits and risks of I-131 therapy in patients with well-differentiated thyroid cancer

Thyroid. 2009 Dec;19(12):1381-91. doi: 10.1089/thy.2009.1611.


Background: I-131 has been used in the therapy of well-differentiated thyroid cancer for over 50 years. Although the benefits and risks of I-131 remain issues of controversy and research, our understanding of them continues to improve. This review presents an overview of the benefits of I-131 therapy for ablation, adjuvant treatment, and treatment of locoregional and/or metastasis of well-differentiated thyroid cancer and considers the risks of complications of I-131 therapy.

Summary: The benefits of I-131 remnant ablation include: [1] facilitating the interpretation of subsequent serum thyroglobulin levels, [2] increasing the sensitivity of detection of locoregional and/or metastatic disease on subsequent follow-up radioactive iodine whole-body scans, [3] maximizing the therapeutic effect of subsequent treatments, and [4] allowing a postablation scan to help identify additional sites of disease that were not identified on the preablation scan or when a preablation scan was not performed. The potential benefits of I-131 adjuvant treatment include decreasing recurrence and disease-specific mortality for unknown microscopic, locoregional, and/or distant metastatic disease. The potential benefits of I-131 treatment of known locoregional and/or distant metastases are [1] decreasing recurrence, and [2] decreasing disease-specific mortality and/or palliation. The more significant risks and side effects involve organ systems including eye/nasolacrimal, salivary, pulmonary, gastrointestinal, hematopoietic, and gonads as well as secondary primary malignancies.

Conclusions: Although there are never-ending controversies regarding I-131 therapy in well-differentiated thyroid cancer, the benefits and risks are becoming better understood. This in turn helps the treating physician and patient in making decisions regarding therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Humans
  • Iodine Radioisotopes / adverse effects
  • Iodine Radioisotopes / therapeutic use*
  • Lung Neoplasms / radiotherapy
  • Lung Neoplasms / secondary
  • Neoplasms, Second Primary / etiology
  • Radiotherapy, Adjuvant
  • Risk Assessment
  • Thyroglobulin / blood
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / radiotherapy*
  • Whole Body Imaging


  • Iodine Radioisotopes
  • Thyroglobulin