2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer?
ETA · 2021 · Europe
Source and licence
- Authors
- Furio Pacini, Dagmar Fuhrer, Rossella Elisei et al.
- Title
- 2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer?
- Journal
- European Thyroid Journal, 2021
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC9142814
Licence statement of the original publication
This work is licensed under a Creative Commons Attribution 4.0 International License.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Risk stratification to assess the need for post-operative RAI administration
- Recommendation 1The decision for post-operative RAI therapy should be taken based on initial prognostic indicators for thyroid cancer related death and recurrence, including among others the surgical and pathological report and on the results of serum Tg measurements and neck ultrasonography obtained after surgery.
- RAI therapy should be based on initial prognostic indicators for thyroid cancer-related death and recurrence
- The use of I-131 therapy as adjuvant treatment or treatment of known disease is indicated in the high-risk group
- In the intermediate-risk category, RAI therapy may be indicated according to individual risk factors
- In low-risk patients, RAI therapy should be based on individual risk modifiers
- Recombinant human TSH is preferred for TSH stimulation
- Activities of 1110 MBq are equally effective as higher activities for remnant ablation
- Before RAI therapy diagnostic scan is not routinely required
- Before RAI therapy any iodine-containing drug should be avoided
- Recommendation 2The use of I-131 therapy as adjuvant treatment or treatment of known disease is indicated for patients in the high risk of recurrence category or with known structural disease. In this setting, high activities (≥3700 MBq)of radioiodine are preferred over low activities.
- Recommendation 3In the intermediate-risk category, RAI therapy may be indicated and should be tailored according to individual cases.
- Recommendation 4In low-risk patients, the benefit of I-131 therapy is a matter of intensive scientific debate and the decision on whether to perform RAI therapy should be based on the presence of individual risk modifiers.
Preparation for RAI administration
- Recommendation 5Recombinant human TSH during l-T4 treatment should be the preferred method of preparation for RAI administration.
Activity of I-131 to be employed for post-surgical thyroid remnant ablation
- Recommendation 6Activities of 1110 MBq are equally effective as higher activities for ablation of presumably benign thyroid remnants.
Should diagnostic RAI scanning be performed before RAI therapy?
- Recommendation 7Whenever a decision to perform post-operative RAI therapy needs to be taken, a diagnostic scan is not routinely required.
Is a low-iodine diet necessary before RAI administration?
- Recommendation 8A low-iodine diet may be prescribed but its utility is not demonstrated unequivocally. Any iodine-containing drug should be avoided.
Abstract
Modern use of post-operative radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC) should be implemented in line with patients’ risk stratification. Although beneficial effects of radioiodine are undisputed in high-risk patients, controversy remains in intermediate-risk and some low-risk patients. Since the last consensus on post-surgical use of RAI in DTC patients, new retrospective data and results of prospective randomized trials have been published, which have allowed the development of a new European Thyroid Association (ETA) statement for the indications of post-surgical RAI therapy in DTC. Questions about which patients are candidates for RAI therapy, which activities of RAI can be used, and which modalities of pre-treatment patient preparation should be used are addressed in the present guidelines.
Contents of the original publication
The section headings of the original.
- Introduction
- Definition of RAI therapy
- Risk stratification to assess the need for post-operative RAI administration
- Preparation for RAI administration
- Activity of I-131 to be employed for post-surgical thyroid remnant ablation
- Should diagnostic RAI scanning be performed before RAI therapy?
- Is a low-iodine diet necessary before RAI administration?
- Conclusions
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