Radioiodine therapy and whole-body iodine scanning
Using the thyroid's natural appetite for iodine to image and treat thyroid cancer with a radioactive form of it. The oldest theranostic, and now used more selectively than it was.
Overview
I-123 or low-activity I-131 scans map iodine-avid tissue; therapeutic I-131 ablates remnants or treats metastases. Randomised trials (HiLo, ESTIMABL1/2, IoN) have progressively reduced activity and then removed ablation for low-risk disease. Refractory disease (no uptake, or progression despite uptake) defines the population for kinase inhibitors; redifferentiation with MEK/BRAF inhibitors can restore uptake in selected patients.
How it works
Thyroid cells take up iodine through the sodium-iodide symporter after TSH stimulation; the beta emission treats, the gamma emission images.
- Highly selective without any engineered targeting
- Cheap, oral, curative in iodine-avid metastatic disease
- Dedifferentiated tumours lose uptake
- Salivary toxicity; radiation precautions; second cancers at high cumulative activity
The original targeted radiotherapy: thyroid cells soak up iodine, so radioactive iodine destroys leftover thyroid tissue and metastases while sparing everything else.
Thyrogen is an injected version of thyroid-stimulating hormone that lets people with thyroid cancer have radioiodine treatment and follow-up blood tests without stopping their thyroid hormone tablets and suffering weeks of hypothyroidism.
Latest papers
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