Guidelines for radioiodine therapy of differentiated thyroid cancer



The purpose of the present guidelines on the radioiodine therapy (RAIT) of differentiated thyroid cancer (DTC) formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians and other members of the DTC-treating community on how to ablate thyroid remnant or treat inoperable advanced DTC or both employing large 131-iodine (131I) activities.


For this purpose, recommendations have been formulated based on recent literature and expert opinion regarding the rationale, indications and contraindications for these procedures, as well as the radioiodine activities and the administration and patient preparation techniques to be used. Recommendations also are provided on pre-RAIT history and examinations, patient counselling and precautions that should be associated with 131I iodine ablation and treatment. Furthermore, potential side effects of radioiodine therapy and alternate or additional treatments to this modality are reviewed. Appendices furnish information on dosimetry and post-therapy scintigraphy.

This is a preview of subscription content, log in to check access.



beta human chorionic gonadotropin






computed tomography


differentiated thyroid carcinoma


diagnostic whole-body scan


European Association of Nuclear Medicine








131-sodium or potassium iodide






sodium iodine symporter


positron emission tomography




recombinant human thyroid-stimulating hormone


radioiodine therapy


region of interest


post-therapy whole-body scan


single photon emission computed tomography


serum thyroglobulin


thyroid hormone withdrawal or withholding


thyroid-stimulating hormone




whole-body scan


external beam radiotherapy


  1. 1.

    Hodgson NC, Button J, Solorzano CC. Thyroid cancer: is the incidence still increasing? Ann Surg Oncol. 2004;11(12):1093–7.

    PubMed  Google Scholar 

  2. 2.

    Bondeson L, Ljungberg O. Occult thyroid carcinoma at autopsy in Malmo, Sweden. Cancer 1981;47(2):319–23.

    PubMed  CAS  Google Scholar 

  3. 3.

    Dinneen SF, et al. Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades. J Clin Endocrinol Metab. 1995;80(7):2041–5.

    PubMed  CAS  Google Scholar 

  4. 4.

    Durante C, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91(8):2892–9.

    PubMed  CAS  Google Scholar 

  5. 5.

    Casara D, et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med. 1993;34(10):1626–31.

    PubMed  CAS  Google Scholar 

  6. 6.

    Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86(4):1447–63.

    PubMed  CAS  Google Scholar 

  7. 7.

    Eustatia-Rutten CF, et al. Survival and death causes in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2006;91(1):313–9.

    PubMed  CAS  Google Scholar 

  8. 8.

    Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297–306.

    PubMed  CAS  Google Scholar 

  9. 9.

    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.

    PubMed  CAS  Google Scholar 

  10. 10.

    Baudin E, Schlumberger M. New therapeutic approaches for metastatic thyroid carcinoma. Lancet Oncol. 2007;8(2):148–56.

    PubMed  CAS  Google Scholar 

  11. 11.

    Cancer Incidence, Mortality and Prevalence Worldwide. Cancer I.A.f.R.o. Globocan 2005.

  12. 12.

    Pacini F, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154(6):787–803.

    PubMed  CAS  Google Scholar 

  13. 13.

    Cooper DS, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16(2):109–42.

    PubMed  Google Scholar 

  14. 14.

    Rodrigues F, et al. [Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin]. Acta Med Port. 2005;18(1):2–16.

    PubMed  Google Scholar 

  15. 15.

    Dietlein M, et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3). Nuklearmedizin 2007;46(5):213–9.

    PubMed  CAS  Google Scholar 

  16. 16.

    Franzius C, et al. Procedure guideline for radioiodine therapy and (131)iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer. Nuklearmedizin 2007;46(5):224–31.

    PubMed  CAS  Google Scholar 

  17. 17.

    Trattamento e Follow-up del Carcinoma Tiroideo Differenziato della Tiroide. Linee Guida SIE-AIMN-AIFM. 2004;1–75.

  18. 18.

    Links TP, et al. [Guideline ‘Differentiated thyroid carcinoma’, including diagnosis of thyroid nodules]. Ned Tijdschr Geneeskd. 2007;151(32):1777–82.

    PubMed  CAS  Google Scholar 

  19. 19.

    Guidelines for the Management of Thyroid Cancer in Adults, ed. P.U.o.t.R.C.o. Physicians. 2002, London, UK: British Thyroid Association and Royal College of Physicians.

  20. 20.

    Sawka AM, et al. Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004;89(8):3668–76.

    PubMed  CAS  Google Scholar 

  21. 21.

    Pacini F, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005;153(5):651–9.

    PubMed  CAS  Google Scholar 

  22. 22.

    Pacini F, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab. 2006;91(3):926–32.

    PubMed  CAS  Google Scholar 

  23. 23.

    Pilli T, et al. A comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-iodine administered doses for recombinant thyrotropin-stimulated postoperative thyroid remnant ablation in differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(9):3542–6.

    PubMed  CAS  Google Scholar 

  24. 24.

    Hay ID, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879–85.

    PubMed  Google Scholar 

  25. 25.

    Chow SM, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98(1):31–40.

    PubMed  Google Scholar 

  26. 26.

    Pelizzo MR, et al. Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun. 2004;25(6):547–52.

    PubMed  Google Scholar 

  27. 27.

    Robbins RJ, et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006;91(2):498–505.

    PubMed  CAS  Google Scholar 

  28. 28.

    Chiu AC, Delpassand ES, Sherman SI. Prognosis and treatment of brain metastases in thyroid carcinoma. J Clin Endocrinol Metab. 1997;82(11):3637–42.

    PubMed  CAS  Google Scholar 

  29. 29.

    Besic N, et al. The role of radioactive iodine in the treatment of Hürthle cell carcinoma of the thyroid. Thyroid 2003;13(6):577–84.

    PubMed  CAS  Google Scholar 

  30. 30.

    Berg G, et al. Radioiodine ablation and therapy in differentiated thyroid cancer under stimulation with recombinant human thyroid-stimulating hormone. J Endocrinol Investig. 2002;25(1):44–52.

    CAS  Google Scholar 

  31. 31.

    Sandeep TC, et al. Second primary cancers in thyroid cancer patients: a multinational record linkage study. J Clin Endocrinol Metab. 2006;91(5):1819–25.

    PubMed  CAS  Google Scholar 

  32. 32.

    Hackshaw A, et al. 131I activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J Clin Endocrinol Metab. 2007;92(1):28–38.

    PubMed  CAS  Google Scholar 

  33. 33.

    Jarzab B, Handkiewicz-Junak D, Wloch J. Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review. Endocr Relat Cancer. 2005;12(4):773–803.

    PubMed  CAS  Google Scholar 

  34. 34.

    Reynolds J. Comparison of I-131 absorbed radiation doses in children and adults: a tool for estimating therapeutic I-131 doses in children. In: Robbins J, editor. Treatment of thyroid cancer in children. Washington, DC: US Department of Energy and US Department of Commerce, Technology, Administration, National Technical Information; 1993. p. 127–35.

    Google Scholar 

  35. 35.

    Leeper RD. The effect of 131 I therapy on survival of patients with metastatic papillary or follicular thyroid carcinoma. J Clin Endocrinol Metab. 1973;36(6):1143–52.

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Beierwaltes WH, et al. Survival time and “cure” in papillary and follicular thyroid carcinoma with distant metastases: statistics following University of Michigan therapy. J Nucl Med. 1982;23(7):561–8.

    PubMed  CAS  Google Scholar 

  37. 37.

    Bernier MO, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2001;86(4):1568–73.

    PubMed  CAS  Google Scholar 

  38. 38.

    Pacini F, et al. Outcome of 309 patients with metastatic differentiated thyroid carcinoma treated with radioiodine. World J Surg. 1994;18(4):600–4.

    PubMed  CAS  Google Scholar 

  39. 39.

    Song H, et al. Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases. J Nucl Med. 2006;47(12):1985–94.

    PubMed  CAS  Google Scholar 

  40. 40.

    Sisson JC, Carey JE. Thyroid carcinoma with high levels of function: treatment with (131)I. J Nucl Med. 2001;42(6):975–83.

    PubMed  CAS  Google Scholar 

  41. 41.

    Maxon HR 3rd, et al. Radioiodine-131 therapy for well-differentiated thyroid cancer—a quantitative radiation dosimetric approach: outcome and validation in 85 patients. J Nucl Med. 1992;33(6):1132–6.

    PubMed  Google Scholar 

  42. 42.

    Benua RS, et al. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. Am J Roentgenol Radium Ther Nucl Med. 1962;87:171–82.

    PubMed  CAS  Google Scholar 

  43. 43.

    Freudenberg L, Jentzen W, Goerges R, Petrich T, Marlowe RJ, Knust J, Bockisch A. 124I-PET dosimetry in advanced differentiated thyroid cancer. Therapeutic impact. Nuklearmedizin 2007;46:121–8.

    PubMed  CAS  Google Scholar 

  44. 44.

    Lassmann M, Hänscheid H, Chiesa C, Hindorf C, Flux G, Luster M. EANM Dosimetry Committee series on standard operational procedures for pre-therapeutic dosimetry I: blood and bone marrow dosimetry in differentiated thyroid cancer therapy. Eur J Nucl Med Mol Imaging. 2008;35(7):1405–12. doi:10.1007/s00259-008-0761-x.

    PubMed  Google Scholar 

  45. 45.

    Murcutt G, et al. Hemodialysis of chronic kidney failure patients requiring ablative radioiodine therapy. Kidney Int. 2008;73(11):1316–9.

    PubMed  CAS  Google Scholar 

  46. 46.

    Alevizaki C, et al. Iodine 131 treatment for differentiated thyroid carcinoma in patients with end stage renal failure: dosimetric, radiation safety, and practical considerations. Hormones (Athens) 2006;5(4):276–87.

    Google Scholar 

  47. 47.

    Duntas LH, Biondi B. Short-term hypothyroidism after levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences. Eur J Endocrinol. 2007;156(1):13–9.

    PubMed  CAS  Google Scholar 

  48. 48.

    Luster M, et al. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid 2005;15(10):1147–55.

    PubMed  CAS  Google Scholar 

  49. 49.

    Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 1997;7(4):613–9.

    PubMed  CAS  Google Scholar 

  50. 50.

    Schroeder PR, et al. A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab. 2006;91(3):878–84.

    PubMed  CAS  Google Scholar 

  51. 51.

    Botella-Carretero JI, et al. Quality of life and psychometric functionality in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2003;10(4):601–10.

    PubMed  CAS  Google Scholar 

  52. 52.

    Botella-Carretero JI, et al. Chronic thyrotropin-suppressive therapy with levothyroxine and short-term overt hypothyroidism after thyroxine withdrawal are associated with undesirable cardiovascular effects in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2004;11(2):345–56.

    PubMed  CAS  Google Scholar 

  53. 53.

    Botella-Carretero JI, et al. The effects of thyroid hormones on circulating markers of cell-mediated immune response, as studied in patients with differentiated thyroid carcinoma before and during thyroxine withdrawal. Eur J Endocrinol. 2005;153(2):223–30.

    PubMed  CAS  Google Scholar 

  54. 54.

    Botella-Carretero JI, et al. Effects of thyroid hormones on serum levels of adipokines as studied in patients with differentiated thyroid carcinoma during thyroxine withdrawal. Thyroid 2006;16(4):397–402.

    PubMed  CAS  Google Scholar 

  55. 55.

    Billewicz WZ, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med. 1969;38(150):255–66.

    PubMed  CAS  Google Scholar 

  56. 56.

    Tagay S, et al. Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment. Eur J Endocrinol. 2005;153(6):755–63.

    PubMed  CAS  Google Scholar 

  57. 57.

    Ladenson PW, et al. Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma. N Engl J Med. 1997;337(13):888–96.

    PubMed  CAS  Google Scholar 

  58. 58.

    Haugen BR, et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab. 1999;84(11):3877–85.

    PubMed  CAS  Google Scholar 

  59. 59.

    Borget I, et al. Sick leave for follow-up control in thyroid cancer patients: comparison between stimulation with Thyrogen and thyroid hormone withdrawal. Eur J Endocrinol. 2007;156(5):531–8.

    PubMed  CAS  Google Scholar 

  60. 60.

    Nijhuis TF, van Wepperen W, de Klerk JMH. Costs associated with the withdrawal of thyroid hormone suppression therapy during the follow-up treatment of well-differentiated thyroid cancer. Tijd Nucl Geneeskd. 1999;21:98–100.

    Google Scholar 

  61. 61.

    Leclere J, Nunez S, Dejaz C, Sohmer V, Schvartz C. Quantitative and qualitative consequences of l-T4 suppressive withdrawal. 3 September 2000: Satellite Symposium Presentation, EANM Annual Congress, Paris, France.

  62. 62.

    Grigsby PW, et al. Preparation of patients with thyroid cancer for 131I scintigraphy or therapy by 1–3 weeks of thyroxine discontinuation. J Nucl Med. 2004;45(4):567–70.

    PubMed  Google Scholar 

  63. 63.

    Kuijt WJ, Huang SA. Children with differentiated thyroid cancer achieve adequate hyperthyrotropinemia within 14 days of levothyroxine withdrawal. J Clin Endocrinol Metab. 2005;90(11):6123–5.

    PubMed  CAS  Google Scholar 

  64. 64.

    Luster M. Acta Oncologica Lecture. Present status of the use of recombinant human TSH in thyroid cancer management. Acta Oncol. 2006;45(8):1018–30.

    PubMed  CAS  Google Scholar 

  65. 65.

    Tuttle RM, et al. Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med. 2008;49(5):764–70.

    PubMed  Google Scholar 

  66. 66.

    Barbaro D, et al. Radioiodine treatment with 30 mCi after recombinant human thyrotropin stimulation in thyroid cancer: effectiveness for postsurgical remnants ablation and possible role of iodine content in l-thyroxine in the outcome of ablation. J Clin Endocrinol Metab. 2003;88(9):4110–5.

    PubMed  CAS  Google Scholar 

  67. 67.

    Barbaro D, et al. Recombinant human thyroid-stimulating hormone is effective for radioiodine ablation of post-surgical thyroid remnants. Nucl Med Commun. 2006;27(8):627–32.

    PubMed  CAS  Google Scholar 

  68. 68.

    Pacini F, et al. Ablation of thyroid residues with 30 mCi (131)I: a comparison in thyroid cancer patients prepared with recombinant human TSH or thyroid hormone withdrawal. J Clin Endocrinol Metab. 2002;87(9):4063–8.

    PubMed  CAS  Google Scholar 

  69. 69.

    Luster M, et al. rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review. Endocr Relat Cancer. 2005;12(1):49–64.

    PubMed  CAS  Google Scholar 

  70. 70.

    Robbins RJ, Driedger A, Magner J. Recombinant human thyrotropin-assisted radioiodine therapy for patients with metastatic thyroid cancer who could not elevate endogenous thyrotropin or be withdrawn from thyroxine. Thyroid 2006;16(11):1121–30.

    PubMed  CAS  Google Scholar 

  71. 71.

    de Keizer B, et al. Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy. Eur J Nucl Med Mol Imaging. 2003;30(3):367–73.

    PubMed  Google Scholar 

  72. 72.

    Taieb D, Lussato D, Mundler O. Subcutaneous administration of recombinant human thyrotropin as an alternative to thyroid hormone withdrawal in patients with anticoagulated thyroid cancer: preliminary results. Thyroid 2004;14(6):463–4.

    PubMed  CAS  Google Scholar 

  73. 73.

    Hänscheid H, et al. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med. 2006;47(4):648–54.

    PubMed  Google Scholar 

  74. 74.

    Vaiano A, et al. Comparison between remnant and red-marrow absorbed dose in thyroid cancer patients submitted to 131I ablative therapy after rh-TSH stimulation versus hypothyroidism induced by l-thyroxine withdrawal. Nucl Med Commun. 2007;28(3):215–23.

    PubMed  CAS  Google Scholar 

  75. 75.

    Borget I, Schlumberger M, Allyn M, De Pouvoirville G, Remy H, Ricard M. Radioiodine ablation in thyroid cancer patients: comparison of length and cost of hospital stay between preparation by thyroid hormone withdrawal and Thyrogen. Eur J Endocrinol 2008; in press.

  76. 76.

    Pluijmen MJ, et al. Effects of low-iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2003;58(4):428–35.

    CAS  Google Scholar 

  77. 77.

    Maxon HR, et al. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med. 1983;309(16):937–41.

    PubMed  CAS  Google Scholar 

  78. 78.

    Pentlow KS, et al. Quantitative imaging of iodine-124 with PET. J Nucl Med. 1996;37(9):1557–62.

    PubMed  CAS  Google Scholar 

  79. 79.

    Sgouros G, et al. Patient-specific dosimetry for 131I thyroid cancer therapy using 124I PET and 3-dimensional-internal dosimetry (3D-ID) software. J Nucl Med. 2004;45(8):1366–72.

    PubMed  CAS  Google Scholar 

  80. 80.

    Mandel SJ, Mandel L. Radioactive iodine and the salivary glands. Thyroid. 2003;13(3):265–71.

    PubMed  CAS  Google Scholar 

  81. 81.

    Nakada K, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med. 2005;46(2):261–6.

    PubMed  Google Scholar 

  82. 82.

    Berg G, et al. Consequences of inadvertent radioiodine treatment of Graves’ disease and thyroid cancer in undiagnosed pregnancy. Can we rely on routine pregnancy testing? Acta Oncol. 2008;47(1):145–9.

    PubMed  CAS  Google Scholar 

  83. 83.

    Schlumberger M, et al. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients. J Nucl Med. 1996;37(4):606–12.

    PubMed  CAS  Google Scholar 

  84. 84.

    Ceccarelli C, et al. 131I therapy for differentiated thyroid cancer leads to an earlier onset of menopause: results of a retrospective study. J Clin Endocrinol Metab. 2001;86(8):3512–5.

    PubMed  CAS  Google Scholar 

  85. 85.

    Krassas GE, Perros P. Thyroid disease and male reproductive function. J Endocrinol Investig. 2003;26(4):372–80.

    CAS  Google Scholar 

  86. 86.

    Kolbert KS, et al. Prediction of absorbed dose to normal organs in thyroid cancer patients treated with 131I by use of 124I PET and 3-dimensional internal dosimetry software. J Nucl Med. 2007;48(1):143–9.

    PubMed  CAS  Google Scholar 

  87. 87.

    Mattavelli F, et al. Role of surgery in treatment of advanced differentiated thyroid carcinomas. Acta Otorhinolaryngol Ital. 2007;27(2):62–7.

    PubMed  CAS  Google Scholar 

  88. 88.

    Shimaoka K, et al. A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 1985;56(9):2155–60.

    PubMed  CAS  Google Scholar 

  89. 89.

    Williams SD, Birch R, Einhorn LH. Phase II evaluation of doxorubicin plus cisplatin in advanced thyroid cancer: a Southeastern Cancer Study Group Trial. Cancer Treat Rep. 1986;70(3):405–7.

    PubMed  CAS  Google Scholar 

  90. 90.

    Santini F, et al. Cytotoxic effects of carboplatinum and epirubicin in the setting of an elevated serum thyrotropin for advanced poorly differentiated thyroid cancer. J Clin Endocrinol Metab. 2002;87(9):4160–5.

    PubMed  CAS  Google Scholar 

  91. 91.

    Tubiana M, et al. External radiotherapy in thyroid cancers. Cancer 1985;55(9 Suppl):2062–71.

    PubMed  CAS  Google Scholar 

  92. 92.

    Biermann M, et al. Guidelines on radioiodine therapy for differentiated thyroid carcinoma: impact on clinical practice. Nuklearmedizin 2005;44(6):229–34. 236–7.

    PubMed  CAS  Google Scholar 

  93. 93.

    Rosenbluth BD, et al. Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer. Int J Radiat Oncol Biol Phys. 2005;63(5):1419–26.

    PubMed  Google Scholar 

  94. 94.

    Marples B, et al. Low-dose hyper-radiosensitivity: a consequence of ineffective cell cycle arrest of radiation-damaged G2-phase cells. Radiat Res. 2004;161(3):247–55.

    PubMed  CAS  Google Scholar 

  95. 95.

    Keum KC, et al. The role of postoperative external-beam radiotherapy in the management of patients with papillary thyroid cancer invading the trachea. Int J Radiat Oncol Biol Phys. 2006;65(2):474–80.

    PubMed  Google Scholar 

  96. 96.

    Meadows KM, et al. External beam radiotherapy for differentiated thyroid cancer. Am J Otolaryngol. 2006;27(1):24–8.

    PubMed  Google Scholar 

  97. 97.

    Mazzarotto R, et al. The role of external beam radiotherapy in the management of differentiated thyroid cancer. Biomed Pharmacother. 2000;54(6):345–9.

    PubMed  CAS  Google Scholar 

  98. 98.

    Brierley JD, Tsang RW. External-beam radiation therapy in the treatment of differentiated thyroid cancer. Semin Surg Oncol. 1999;16(1):42–9.

    PubMed  CAS  Google Scholar 

  99. 99.

    Biermann M. External beam radiotherapy. In: Biersack HJ, Gruenwald F, editors. Thyroid cancer. Heidelberg: Springer; 2005. p. 139–61.

    Google Scholar 

  100. 100.

    Oyen W, et al. Targeted therapy in nuclear medicine—current status and future prospects. Ann Oncol 2007. 1782–92.

  101. 101.

    Haugen BR. Redifferentiation therapy in advanced thyroid cancer. Curr Drug Targets Immune Endocr Metabol Disord. 2004;4(3):175–80.

    PubMed  CAS  Google Scholar 

  102. 102.

    Simon D, et al. Clinical impact of retinoids in redifferentiation therapy of advanced thyroid cancer: final results of a pilot study. Eur J Nucl Med Mol Imaging. 2002;29(6):775–82.

    PubMed  CAS  Google Scholar 

  103. 103.

    Schmutzler C. Regulation of the sodium/iodide symporter by retinoids—a review. Exp Clin Endocrinol Diabetes. 2001;109(1):41–4.

    PubMed  CAS  Google Scholar 

  104. 104.

    Liu YY, et al. Bexarotene increases uptake of radioiodide in metastases of differentiated thyroid carcinoma. Eur J Endocrinol. 2006;154(4):525–31.

    PubMed  CAS  Google Scholar 

  105. 105.

    Zhang Y, et al. A clinical study of all-trans-retinoid-induced differentiation therapy of advanced thyroid cancer. Nucl Med Commun. 2007;28(4):251–5.

    PubMed  CAS  Google Scholar 

  106. 106.

    Cramer M, Luster M, Fuehrer D, Schmutzler C, Beer M, Morganthaler NG, et al. Retinsäurebehandlung und Verlauf eines initial nicht iodaviden gering differenzierten Schilddrüsenkarzinoms bei einer Patientin mit TSH-Rezeptor-blockierenden Antikörpern. Nuklearmedizin 2008;47:N25–8.

    Google Scholar 

  107. 107.

    Tharp K, Israel O, Hausmann J, Bettman L, Martin WH, Daitzchman M, et al. Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2004;31:1435–442.

    PubMed  CAS  Google Scholar 

  108. 108.

    Hyer S, et al. Salivary gland toxicity after radioiodine therapy for thyroid cancer. Clin Oncol (R Coll Radiol). 2007;19(1):83–6.

    CAS  Google Scholar 

  109. 109.

    Hyer S, et al. Testicular dose and fertility in men following I(131) therapy for thyroid cancer. Clin Endocrinol (Oxf). 2002;56(6):755–8.

    CAS  Google Scholar 

  110. 110.

    Wichers M, et al. Testicular function after radioiodine therapy for thyroid carcinoma. Eur J Nucl Med. 2000;27(5):503–7.

    PubMed  CAS  Google Scholar 

  111. 111.

    Reiners C, Lassmann M, Hanscheid H. A perspective on post-Chernobyl radioablation in young females. J Nucl Med. 2006;47(10):1563–4.

    PubMed  Google Scholar 

  112. 112.

    Rubino C, et al. Second primary malignancies in thyroid cancer patients. Br J Cancer. 2003;89(9):1638–44.

    PubMed  CAS  Google Scholar 

  113. 113.

    de Vathaire F, et al. Leukaemias and cancers following iodine-131 administration for thyroid cancer. Br J Cancer. 1997;75(5):734–9.

    PubMed  Google Scholar 

  114. 114.

    Chen AY, et al. The development of breast carcinoma in women with thyroid carcinoma. Cancer 2001;92(2):225–31.

    PubMed  CAS  Google Scholar 

  115. 115.

    Maxon HR 3rd, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am. 1990;19(3):685–718.

    PubMed  Google Scholar 

  116. 116.

    Siegel JA, et al. MIRD pamphlet no. 16: techniques for quantitative radiopharmaceutical biodistribution data acquisition and analysis for use in human radiation dose estimates. J Nucl Med. 1999;40(2):37S–61S.

    PubMed  CAS  Google Scholar 

  117. 117.

    Snyder W, Ford MR, Warner GG, et al. MIRD pamphlet no. 11: S, absorbed dose per unit cumulated activity for selected radionuclides and organs. New York, NY: Society of Nuclear Medicine; 1975.

    Google Scholar 

  118. 118.

    Dietlein M, et al. [Procedure guideline for radioiodine test (version 3)]. Nuklearmedizin 2007;46(5):198–202.

    PubMed  CAS  Google Scholar 

  119. 119.

    Stabin MG, Sparks RB, Crowe E. OLINDA/EXM: the second-generation personal computer software for internal dose assessment in nuclear medicine. J Nucl Med. 2005;46(6):1023–7.

    PubMed  Google Scholar 

  120. 120.

    Menzel C, et al. “High-dose” radioiodine therapy in advanced differentiated thyroid carcinoma. J Nucl Med. 1996;37(9):1496–503.

    PubMed  CAS  Google Scholar 

  121. 121.

    Crawford DC, et al. Thyroid volume measurement in thyrotoxic patients: comparison between ultrasonography and iodine-124 positron emission tomography. Eur J Nucl Med. 1997;24(12):1470–8.

    PubMed  CAS  Google Scholar 

  122. 122.

    Eschmann SM, et al. Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET. Eur J Nucl Med Mol Imaging. 2002;29(6):760–7.

    PubMed  CAS  Google Scholar 

  123. 123.

    Lassmann M, et al. Impact of 131I diagnostic activities on the biokinetics of thyroid remnants. J Nucl Med. 2004;45(4):619–25.

    PubMed  Google Scholar 

  124. 124.

    Leeper RD. Thyroid cancer. Med Clin North Am. 1985;69(5):1079–96.

    PubMed  CAS  Google Scholar 

  125. 125.

    Luster M, et al. Comparison of radioiodine biokinetics following the administration of recombinant human thyroid stimulating hormone and after thyroid hormone withdrawal in thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2003;30(10):1371–7.

    PubMed  CAS  Google Scholar 

  126. 126.

    Thomas SR, et al. Predictive estimate of blood dose from external counting data preceding radioiodine therapy for thyroid cancer. Nucl Med Biol. 1993;20(2):157–62.

    PubMed  CAS  Google Scholar 

  127. 127.

    Medvedec M. Thyroid stunning in vivo and in vitro. Nucl Med Commun. 2005;26(8):731–5.

    PubMed  Google Scholar 

  128. 128.

    Tuttle RM, et al. Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med. 2006;47(10):1587–91.

    PubMed  Google Scholar 

  129. 129.

    Samuel AM, Rajashekharrao B, Shah DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer. J Nucl Med. 1998;39(9):1531–6.

    PubMed  CAS  Google Scholar 

Download references


The authors thank Professor Furio Pacini of the University of Siena and Robert J. Marlowe for their critical reviews of the manuscript. Development of this paper was supported by a grant from Genzyme Europe B.V.

Author information



Corresponding author

Correspondence to M. Luster.


Chart 1. Indications and contraindications radioiodine treatment of DTC

A. Definite indications

  1. 1.

    Unresectable iodine-avid lymph node metastases where one or more of the following is true:

    • morphological imaging does not reveal location

    • surgery is high-risk or contraindicated

    • distant involvement is present that would indicate RAIT anyways

  2. 2.

    Iodine-avid pulmonary micrometastases, especially before they become visible on CT

  3. 3.

    Non-resectable or partially resectable iodine-avid pulmonary macrometastases

  4. 4.

    Non-resectable or partially resectable iodine-avid soft tissue metastases

B. Optional indications

  1. 1.

    Recurrent iodine-avid lymph node or distant metastases, as an adjuvant to surgery

  2. 2.

    Unresectable iodine-avid lymph node metastases where one or more of the following is true:

    • size is small

    • involvement includes numerous nodes or is widespread

  3. 3.

    Non-resectable or partially resectable iodine-avid bone metastases, especially when symptomatic or threatening vital structures

  4. 4.

    Known or suspected metastatic DTC where iodine avidity is not yet known, especially if Tg is detectable or increasinga

  5. 5.

    Anaplastic or poorly differentiated thyroid carcinomas that have (relevant) well-differentiated areas or express Tg, especially if symptomatic or progressiveb

C. Non-indications

  1. 1.

    Iodine non-avid lymph node metastases

  2. 2.

    Iodine non-avid lung macrometastases

  3. 3.

    Iodine non-avid bone metastases

D. Contraindications

  1. 1.


  2. 2.


  3. 3.

    Clinically relevant bone marrow depression when high-activity RAIT is planned (relative contraindication)

  4. 4.

    Clinically relevant pulmonary function restriction together with expected important accumulation in lung metastases (relative contraindication)

  5. 5.

    Clinically relevant salivary gland restriction, especially if 131I accumulation in known lesions is questionable (relative contraindication)


CT, computed tomography; DTC, differentiated thyroid carcinoma; 131I, 131-iodine; RAIT, radioiodine therapy; Tg, thyroglobulin


aThese patients should receive an initial course of RAIT, and if the rxWBS is negative, RAIT should be discontinued.

bIn these patients, the indication for XRT and the urgency of RAIT should be considered in the decision on whether to give RAIT.

Appendix 1. Pre-therapeutic dosimetry concepts for radioiodine therapy

Pre-therapeutic dosimetry for RAIT may take either or both of two forms: (1) remnant- and lesion-based dosimetry and (2) bone marrow (blood) dosimetry.

A. Remnant- and lesion-based dosimetry

  1. 1.


    The objective of remnant or lesion dosimetry, sometimes referred to as the “Maxon approach” in honour of one of its key developers, is to determine the individualised radioiodine activity that delivers the recommended doses of radiation to ablate thyroid remnant or to treat metastatic disease whilst minimising the risk to the patient. These absorbed doses are traditionally considered to be ≥300 Gy to ablate thyroid remnant and ≥80 Gy to successfully treat metastatic disease [115]. Individualising the RAIT activity may help avoid over- or under-treating the remnant, tumour or both, which is presumed to have efficacy or safety benefits, or both.

  2. 2.


    To perform these calculations, it is necessary to measure the uptake and clearance of the 131I from identifiable thyroid remnants, DTC metastases or both. To determine the 131I concentration, one needs to know how much activity is contained in the lesion. One way to determine this is through an analysis of selected ROIs on conjugate view gamma camera images or on SPECT images [116].

    These images are obtained at several time points following the administration of a tracer activity. Typically, these images would be acquired up to 96 h after tracer administration, but later time samples might be necessary if the uptake and clearance are delayed. In addition, transmission images, scatter images or both might be necessary to correct for attenuation or scatter or in the region of the lesion. Images of a standard for calibration purposes might also be needed [116]. A curve-fitting procedure then is used to determine the assumed single-exponential half-life value and to extrapolate the curve to time zero to determine the initial activity in the lesion.

    Pre-therapeutic dosimetric assessments of the activity required to achieve a certain prescribed absorbed dose to a remnant or lesion are often based on adaptations of the generic MIRD equation for absorbed dose [117]:

    $$\overline D = \frac{{\tilde A \times S \times m_{\text{r}} }}{{m_{\text{t}} }}$$

    where \(\overline D \) denotes the mean absorbed dose to the remnant/lesion, \(\tilde A\), the cumulative activity (the integral of the activity–time curve), m r, the reference mass of the thyroid (20.7 g), and m t is the remnant/lesion mass. S is the MIRD-defined S value for thyroid self-irradiation (5.652 × 10−3 Gy MBq−1 h−1, see MIRD Pamphlet 11 [117] or, for example, the guidelines of the German Society of Nuclear Medicine [118]).

  3. 3.

    Mass determination

    The lesion mass is another variable needed in order to calculate the activity concentration delivering the required absorbed dose. For ablation therapies, remnant volumetry methods such as US or CT are unreliable, as it is impossible to differentiate thyroid tissue from haematoma on these modalities. Thus no thoroughly validated method yet exists to exactly determine the mass of thyroid remnants after surgery [73]. For this reason, one must be careful when reporting absorbed doses to the target tissue. For lesion dosimetry, higher spatial resolution images, such as those obtained with CT or US, can be used for attenuation correction and to determine the mass.

    If the lesions are small, the nodule module of the OLINDA/EXM software might be useful to generate a spherical model of the remnant, tumour or both [119]. Furthermore, if the dimensions of the lesions are smaller than approximately 5 mm—assuming that this could be accurately determined—then the range of the beta particles can no longer be neglected in the dose calculation [120].

  4. 4.

    PET-based lesion dosimetry

    The use of 124I was proposed for quantifying in vivo tumour radioiodine concentration and biodistribution in DTC patients [78, 79, 121, 122]. Due to the complex decay process of 124I, the quantification process cannot be performed in the same way as for the pure positron emitter FDG. Pentlow et al. [78] measured resolution, linearity and the ability to quantify the activity contents of imaged spheres of different sizes and activities in different background activities. It was shown that the 124I quantification could reproduce the activities administered. 124I PET was also successfully applied to the measurement of thyroid volume [121, 122]. Today’s state-of-the-art 124I PET-based DTC dosimetry protocol has been described in recent publications by Sgouros et al. [79]. Using the PET results as input to a fully three-dimensional dose planning programme, those investigators calculated spatial distributions of absorbed doses, isodose contours, dose–volume histograms and mean absorbed dose estimates for a total of 56 tumours. The mean tumour absorbed dose for each patient ranged widely, from 1.2 to 540 Gy. The absorbed dose distribution for individual tumour voxels was even more widely distributed, ranging from 0.3 to 4,000 Gy.

    Findings similar to those of the Sgorous and coworkers study, of median per-patient tumour radiation absorbed doses between 1.3 and 368 Gy, were recently reported by de Keizer et al. [71] who performed tumour dosimetry after rhTSH-stimulated 131I treatment. Dosimetric calculations were performed using tumour radioiodine uptake measurements from post-treatment 131I scintigrams and tumour volume estimations were generated from radiological images.

  5. 5.


    The main disadvantages of a lesion-based approach to RAIT dosimetry in DTC are:

    • Absorbed lesion doses range widely even within a single patient.

    • Contrary to assumptions inherent in dosimetry protocols, absorbed dose distributions vary within lesions, which could result in incomplete tumour destruction.

    • A mono-exponential model may not accurately reflect lesional radioiodine kinetics.

    • Unclearly defined correction factors must be applied for the initial phase of increasing uptake (up to approximately 24 h post-radioiodine administration).

    • An accurate estimate of the lesion mass is not always possible, e.g. with disseminated iodine-avid lung metastases or irregularly shaped lesions.

    • Low uptake in lesions and, therefore, low count rates may cause statistical errors in the measurements.

    • The biological effectiveness of dosimetry-guided RAIT is not proven yet.

    • Doses may be systematically underestimated for lesions <5 mm in diameter if no corrections are applied.

In addition, currently, when 131I is used, relatively high diagnostic activities, i.e. at least 37 MBq, are necessary for quantitative imaging of the target thyroid tissue for dosimetry; these activities have the potential to induce “stunning” (see the “Precautions” section above), which is a particularly critical consideration in radioiodine treatment of metastatic disease [123].

B. Bone marrow (blood) dosimetry

  1. 1.


    The method originally reported by Benua et al. [42] and Leeper [124] allows the estimation of the radiation dose that will be delivered to the haematopoietic system from each GBq administered to any patient. The method involves measurement of radiation counts of serial blood samples and serial calibrated probe measurements of the patient’s whole-body activity over the course of 4 or more days after 131I tracer administration. The original Benua et al. study [42] determined that the subgroup of patients who received ≤2 Gy to the blood avoided serious myelosuppression; this dose has become the principal traditionally accepted safety threshold for RAIT. In addition, the whole-body retention at 48 h after radioiodine administration should not exceed 4.44 GBq (120 mCi) in the absence of iodine-avid diffuse lung metastases or 2.96 GBq (80 mCi) in the presence of such lesions [39].

  2. 2.

    More recent developments

    In the classic Benua approach, the blood is considered the critical organ that is irradiated either by the particles emitted from activity in the blood itself or by the emissions originating from activity dispersed throughout the remainder of the body. Recently, in the framework of international multi-centre studies of radioiodine biokinetics after rhTSH administration [125], the absorbed dose to the blood was calculated with a modified method derived from a procedure originally described by Thomas et al. [126]. Refinements to this model have been introduced to account for:

    • the contribution to the blood dose of penetrating radiation from activity in distant blood,

    • the mass dependency of the S value representing the radiation from the total body to the blood,

    • a mean value, \(S_{{\text{blood}} \leftarrow {\text{blood}}} \), representing an average for blood circulating in vessels of varying diameters and s values [44].

The recent studies show that the results of pre-therapeutic blood-based dosimetry agree well with measured post-therapeutic absorbed doses. Therefore, the pre-therapeutic data can reliably project therapeutic absorbed doses to blood.

For blood-based dosimetry, only two compartments need be monitored for radioactivity: the blood and the gamma ray absorbed doses to the whole body. The activity in the blood is determined by measuring periodic heparinised blood samples. The activity in the whole body, i.e. remaining in the patient, can be monitored redundantly using independent techniques: 24-h urine collections, whole-body counting with a probe using a fixed geometry and, if applicable, conjugate views of a WBS obtained with a dual-headed gamma camera.

Details regarding the sampling times, measurements and calculations can be found in the EANM Dosimetry Committee Series on Standard Operational Procedures for Pre-Therapeutic Dosimetry (I. Blood and Bone Marrow Dosimetry in Differentiated Thyroid Cancer Therapy) [44].

The recommended equation for the absorbed dose to the blood per unit of administered activity [44] is:

$$\frac{{D_{{\text{blood}}} }}{{A_0 }}\left[ {\frac{{{\text{Gy}}}}{{{\text{GBq}}}}} \right] = 108 \times \tau _{{\text{ml}}\;{\text{of}}\,{\text{blood}}} \left[ {\text{h}} \right] + \frac{{0.0188}}{{\left( {{\text{wt}}\left[ {{\text{kg}}} \right]} \right)^{{2 \mathord{\left/ {\vphantom {2 3}} \right. \kern-\nulldelimiterspace} 3}} }} \times \tau _{{\text{total}}\;{\text{body}}} \left[ {\text{h}} \right]$$

τ total body [h] and τ ml of blood [h] stand for the residence time in a source organ, representing the integral of the time–activity curve in that organ (cumulative activity) divided by the administered activity A 0; wt represents the patient’s weight. In addition, the EANM Dosimetry Committee guidelines give a formula for the assessment of the absorbed dose to the bone marrow [44].

The tracer activity necessary for a reliable assessment of the whole-body residence time depends on the equipment used (see Section 3.3 in [44]). The potential risk of the diagnostic absorbed dose dramatically changing the iodine kinetics in target tissue limits the administered activity to amounts much lower than 74 MBq 131I [123]. Under all circumstances, one should avoid administering activities which lead to total absorbed doses to iodine-avid tissue of >5 Gy [127].

An activity of 10–15 MBq of 131I should suffice for a pre-therapeutic blood-based dosimetry assessment. Based on experience to date, this range of activities will provide sufficient count statistics whilst most probably not causing any changes between pre- and post-therapeutic biokinetics of 131I.

  1. 3.

    Strengths and limitations

    The strengths of the blood-based approach are:

    • determination of the maximal safe activity of radioiodine for each RAIT in each individual,

    • identification of patients for whom empiric fixed activities are not safe [128],

    • the potential to administer higher activities once instead of lower activities multiple times in a “fractionated” therapy to avoid changes in lesion biokinetics after multiple therapies that have been observed, e.g. by Samuel et al. [129],

    • a long history of use in several institutions,

    • an expected increase in the probability of curing patients in advanced stage of the disease with fewer courses of therapy.

    Limitations that need to be mentioned are:

    • a benefit of the strategy is plausible, but no valid clinical data yet exist on improved response or outcome rates;

    • the absorbed dose to the tumour is not known: higher activities might be administered without achieving a better therapeutic effect when using this methodology;

    • the current debate regarding the issue of “stunning” argues that diagnostic administrations of 131I could alter lesion biokinetics and, consequently, the absorbed dose in a subsequent RAIT;

    • increased cost and inconvenience, although this may be outweighed by rendering further treatments unnecessary.

Patient-specific blood-based dosimetry is easy to perform both pre-therapeutically and peri-therapeutically and allows the RAIT activity for selected patients to be increased without risk of severe side effects. In addition, simplified protocols have not been tested yet.

Appendix 2. Additional considerations in rxWBS

A. Purpose of rxWBS

Detection and localisation or exclusion of one or more of functioning thyroid remnants, persistent or recurrent local disease or metastases in patients with DTC.

B. Image acquisition

131I rxWBS should employ a gamma camera with a large field of view and a high-energy collimator. Preferably, a camera with a thick, e.g. 2.5 cm, sodium iodide crystal should be used to increase the sensitivity of the scan.

The patient should lie supine on an imaging table with moderate head reclination. Anterior and posterior images should show the whole body. Spot images should be obtained for at least 5–10 min per view. If images are obtained with a whole-body scanner, the scan speed should be adjusted so that whole-body imaging takes at least 20–30 min per view. Longer imaging times may be helpful for images obtained more than 3 days after radioiodine administration.

C. Interpretation and quantification

rxWBS images should be interpreted visually for location of functional tissue. The quantification of radioiodine uptake in functioning tissue by a ROI technique and by comparison with a calibrated 131I activity can be helpful for post-therapeutic dosimetry and for follow-up data.

D. Reporting and documentation

The report should include the location, size and intensity of any areas of uptake that correspond to any functioning tissue. Description of comparisons with prior images is useful. The results of Tg assays and TSH are helpful for the interpretation of the scintigraphic findings.

Documentation (radiographic films or paper prints or computer files) should include:

  • patient’s name for identification,

  • radiopharmaceutical administered,

  • activity administered in MBq,

  • timing of the images in relation to radiopharmaceutical administration,

  • acquisition time in minutes and counts acquired,

  • in the case of functioning tissue, imaging of ROIs of the hot spot, of background activity and of calibrated activity (for dosimetry purposes).

E. Quality control

Many national nuclear medicine societies have written guidelines to promote the cost-effective use of high-quality nuclear medicine procedures. Relevant parameters of quality control for gamma cameras are, e.g. background activity, energy window, homogeneity, spatial resolution and linearity.

F. Error: potential sources and avoidance

Potential sources of error in rxWBS interpretation include:

  • local contamination (clothing, skin, hair, collimator, crystal),

  • oesophageal activity,

  • asymmetrical salivary gland uptake,

  • non-specific uptake, e.g. in pulmonary infections, oedema, the breast, kidney cysts and the thymus.

To avoid artefacts caused by cutaneous contamination with radioiodine, the patient should shower and change underwear before rxWBS.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Luster, M., Clarke, S.E., Dietlein, M. et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 35, 1941 (2008).

Download citation


  • Radioiodine therapy
  • Thyroid remnant ablation
  • Radioiodine treatment
  • Guidelines