Radioiodine Therapy in Benign Thyroid Diseases: Effects, Side Effects, and Factors Affecting Therapeutic Outcome

Radioiodine (I-131) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after I-131 therapy. With longer follow-up, permanent hypothyroidism seems inevitable in Graves' disease, whereas this risk is much lower when treating toxic nodular goiter. The side effect causing most concern is the potential induction of ophthalmopathy in predisposed individuals. The response to I-131 therapy is to some extent related to the radiation dose. However, calculation of an exact thyroid dose is error-prone due to imprecise measurement of the I-131 biokinetics, and the importance of internal dosimetric factors, such as the thyroid follicle size, is probably under estimated. Besides these obstacles, several potential confounders interfere with the efficacy of I-131 therapy, and they may even interact mutually and counteract each other. Numerous studies have evaluated the effect of I-131 therapy, but results have been conflicting due to differences in design, sample size, patient selection, and dose calculation. It seems clear that no single factor reliably predicts the outcome from I-131 therapy. The individual radiosensitivity, still poorly defined and impossible to quantify, may be a major determinant of the outcome from I-131 therapy. Above all, the impact of I-131 therapy relies on the iodine-concentrating ability of the thyroid gland. The thyroid I-131 uptake (or retention) can be stimulated in several ways, including dietary iodine restriction and use of lithium. In particular, recombinant human thyrotropin has gained interest because this compound significantly amplifies the effect of I-131 therapy in patients with nontoxic nodular goiter. (Endocrine Reviews 33: 920-980, 2012)