Radioiodine for Low-Risk Thyroid Cancer — the Swinging Pendulum

This editorial discusses the evolving role of radioiodine therapy in low risk differentiated thyroid cancer (DTC), particularly papillary thyroid cancer, which accounts for 80% of cases. Historically, total thyroidectomy followed by radioiodine was standard, but recent evidence suggests most low risk patients (stage I/II) fare well without it. The article highlights a randomized trial by Leboulleux et al. (2022), where 776 low risk DTC patients (tumors ≤2 cm, no aggressive features) showed no significant difference in 3 year recurrence rates between those receiving radioiodine (1.1 GBq) and those untreated (4% events in both groups). Key predictors like thyroglobulin levels (<1 ng/mL) and tumor size (<1.4 cm) were noted, with no impact from BRAF V600E mutations. The decline in radioiodine use, driven by guidelines favoring selective application and lobectomy trends, underscores the need for tailored approaches. Pending trials (e.g., IoN trial) may further refine its role.

This editorial discusses the evolving role of radioiodine therapy in low risk differentiated thyroid cancer (DTC), particularly papillary thyroid cancer, which accounts for 80% of cases. Historically, total thyroidectomy followed by radioiodine was standard, but recent evidence suggests most low risk patients (stage I/II) fare well without it. The article highlights a randomized trial by Leboulleux et al. (2022), where 776 low risk DTC patients (tumors ≤2 cm, no aggressive features) showed no significant difference in 3 year recurrence rates between those receiving radioiodine (1.1 GBq) and those untreated (4% events in both groups). Key predictors like thyroglobulin levels (<1 ng/mL) and tumor size (<1.4 cm) were noted, with no impact from BRAF V600E mutations. The decline in radioiodine use, driven by guidelines favoring selective application and lobectomy trends, underscores the need for tailored approaches. Pending trials (e.g., IoN trial) may further refine its role.