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The carcinogenic effects of radioiodine therapy for thyroid carcinoma

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 180–181 (2008)Cite this article

Thyroid carcinoma tissue usually retains some biological properties of normal thyroid cells, such as thyroglobulin production and radioiodine (131I) uptake. These properties can be exploited in the treatment of persistent or recurrent disease, and during patient follow-up. Radioiodine targets the thyroid tissue and is, therefore, used as a treatment for differentiated papillary and follicular thyroid carcinomas.1 Nevertheless, radioiodine is potentially carcinogenic for other organs and, in the absence of a long-term, randomized, placebo-controlled clinical trial, the risk-to-benefit ratio of radioiodine treatment of localized thyroid carcinoma cannot be objectively assessed. In this Viewpoint, I discuss the risk of second primary malignancies after radioiodine therapy for thyroid carcinoma.

As thyroid carcinoma affects relatively young patients and has a good prognosis, the carcinogenic risk associated with therapeutic administration of radioiodine needs to be quantified. Some organs are of particular concern because radioiodine is actively concentrated in the tissue (e.g. the salivary glands) or because they are the therapeutic route of administration (e.g. the digestive tract). The radiation dose delivered to healthy tissue depends upon three factors: the administered activity, the uptake by the tissue, and the length of time that the isotope resides in the target tissue. Various estimates of radiation doses delivered by radioiodine to healthy tissues have been published. One dosimetric study of multiple organ systems estimated the mean radiation dose to range from 0.029 Gy per GBq for brain to 0.26 Gy per GBq for the salivary glands, whereas the mean radiation dose for blood was 0.12 Gy per GBq.2 These estimates were confirmed in some organ-specific studies, which also demonstrated that the mean values calculated are subject to interindividual variations that reach a factor of 3–6 according to the specific organ or tissue type. In practice, some organs are susceptible to a received dose of about 1 Gy after only two administrations of 3.7 GBq each.

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  1. Unité 605 INSERM, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France fdv@igr.fr

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  1. F de Vathaire is Head of the Unit of Cancer Epidemiology (Unit 605) of the National Institute for Health and Medical Research (INSERM), Villejuif, France.,

    Florent de Vathaire

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de Vathaire, F. The carcinogenic effects of radioiodine therapy for thyroid carcinoma. Nat Rev Endocrinol 4, 180–181 (2008). https://doi.org/10.1038/ncpendmet0761

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