Radioactive iodine in the management of medullary carcinoma of the thyroid

Br J Radiol. 2023 Aug;96(1148):20220660. doi: 10.1259/bjr.20220660. Epub 2023 Jun 29.


Objectives: Although it is generally accepted that medullary thyroid cancer (MTC) cells do not take up iodine, there are reports indicating that this can occur. Additionally, the potential for radioactive iodine (RAI) to reduce the risk of recurrence within the thyroid bed following thyroid remnant ablation in MTC is uncertain. A systematic review was therefore undertaken.

Methods: Studies of patients with MTC of any age or stage receiving RAI, either as adjuvant postoperative treatment or primary treatment for unresectable disease, or as treatment for recurrent or metastatic disease were eligible for inclusion. Randomised and non-randomised studies were identified by electronic searching of Medline and Embase databases. A risk of bias assessment (ROBINS-I) was carried out for each study. Outcome measures sought included overall survival, locoregional relapse-free survival, rates of locoregional recurrence, and changes in serum calcitonin. A protocol was registered with PROSPERO before the systematic review was undertaken.

Results: There were no randomised studies. Ten non-randomised studies (525 patients) and ten case reports (21 patients) met the inclusion criteria, with all studies containing a high risk of bias. There were case reports reporting responses to RAI, both as adjuvant treatment and for recurrent/metastatic disease.

Conclusions: The proportion of metastatic or recurrent MTC which take up iodine remains unknown. A possible role of RAI ablation for patients with localised MTC and raised calcitonin post-thyroidectomy should be explored.

Advances in knowledge: Although there is insufficient data to recommend changes to current treatment policies, this review suggests avenues for further research.

Publication types

  • Systematic Review

MeSH terms

  • Calcitonin
  • Carcinoma, Medullary* / surgery
  • Humans
  • Iodine Radioisotopes / therapeutic use
  • Neoplasm Recurrence, Local / surgery
  • Retrospective Studies
  • Thyroid Neoplasms* / pathology
  • Thyroid Neoplasms* / radiotherapy
  • Thyroid Neoplasms* / surgery
  • Thyroidectomy


  • Iodine Radioisotopes
  • Calcitonin

Supplementary concepts

  • Thyroid cancer, medullary