Journal List > J Korean Thyroid Assoc > v.5(1) > 1056519

Kang, Kim, Kim, Bom, Lee, Lee, Chung, and Chung: Radiation Safety in the Treatment of Patients with Thyroid Disease by 131I


Radioactive iodine (131I) therapy is a well established treatment modality for patient with hyperthyroidism and differentiated thyroid cancer after total thyroidectomy. Patients may sometimes need to be hospitalized to reduce radiation exposure of other people and relatives from radioactive patients receiving 131I therapy. This review was prepared to present suggestions and recommendations to health providers with reasoned instructions on radiation safety for patients, their families, caregivers, and the public after 131I therapy. The recommendations should help to ensure compliance and reduce the potential for harmful radiation exposure to others, and also to recognize that required actions may differ when attaining compliance with existing local regulations of other jurisdictions. Most of reported suggestions and recommendations are based on data derived from relevant measurements of radiation exposure, 131I clearance and excretion, and reports of the impact of precautions in limiting radiation exposure. We have quoted many descriptions from American Thyroid Association Guidelines in this review, which was published recently and emphasize the roles of the treating physician and the radiation safety officer in individualizing the precautions for each patient while allowing the referring physician to assist in preparing appropriate and adequate pre- and post-therapy actions. We tried to summarize the reported scientific papers and recommendations to provide general principle of radiation protection and some delicate issues in radiation safety after radioiodine therapy for the thyroid disease, to lower radiation exposure from patients to public and medical.


1. Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al. Procedure guideline for therapy of thyroid disease with (131)iodine. J Nucl Med. 2002. 43(6):856–861.
2. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008. 35(10):1941–1959.
3. Franzius C, Dietlein M, Biermann M, Fruhwald M, Linden T, Bucsky P, et al. [Procedure guideline for radioiodine therapy and 131Iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer]. Nuklearmedizin. 2007. 46(5):224–231.
4. Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: practice recommendations of the American Thyroid Association. Thyroid. 2011. 21(4):335–346.
5. Barrington SF, Kettle AG, O'Doherty MJ, Wells CP, Somer EJ, Coakley AJ. Radiation dose rates from patients receiving iodine-131 therapy for carcinoma of the thyroid. Eur J Nucl Med. 1996. 23(2):123–130.
6. Culver CM, Dworkin HJ. Radiation safety considerations for post-iodine-131 hyperthyroid therapy. J Nucl Med. 1991. 32(1):169–173.
7. O'Doherty MJ, Kettle AG, Eustance CN, Mountford PJ, Coakley AJ. Radiation dose rates from adult patients receiving 131I therapy for thyrotoxicosis. Nucl Med Commun. 1993. 14(3):160–168.
8. United States Nuclear Regulatory Commission Office of Federal and State Material and Environmental Management Programs 2009 Washington, DC: 20555-0001. NRC Information Notice. 2003. 22:Supplement 2009.
10. Jacobson AP, Plato PA, Toeroek D. Contamination of the home environment by patients treated with Iodine-131: initial results. Am J Public Health. 1978. 68(3):225–230.
11. Harbert JC, Wells N. Radiation exposure to the family of radioactive patients. J Nucl Med. 1974. 15(10):887–888.
12. Berg G, Jacobsson L, Nystrom E, Gleisner KS, Tennvall J. Consequences of inadvertent radioiodine treatment of Graves' disease and thyroid cancer in undiagnosed pregnancy. Can we rely on routine pregnancy testing? Acta Oncol. 2008. 47(1):145–149.
13. Zanzanico PB, Becker DV. Beckers C, Reinwein D, editors. Radiation hazards in children born to mothers exposed 131-iodine. The thyroid and pregnancy. 1991. Stuttgart: Schattauer;189–202.
14. Sawka AM, Lakra DC, Lea J, Alshehri B, Tsang RW, Brierley JD, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf). 2008. 69(3):479–490.
15. Sawka AM, Lea J, Alshehri B, Straus S, Tsang RW, Brierley JD, et al. A systematic review of the gonadal effects of therapeutic radioactive iodine in male thyroid cancer survivors. Clin Endocrinol (Oxf). 2008. 68(4):610–617.
16. Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol (Oxf). 2009. 70(5):803–809.
17. Brzozowska M, Roach PJ. Timing and potential role of diagnostic I-123 scintigraphy in assessing radioiodine breast uptake before ablation in postpartum women with thyroid cancer: a case series. Clin Nucl Med. 2006. 31(11):683–687.
18. ICRP Publication 94. nternational Commission on Radiological Protection 2004 Release of patients after therapy with unsealed radionuclides. Ann ICRP. Section 4: Radiation protection after use of therapeutic radiopharmaceuticals, p. 19; Section 10.5: Doses to others during patient travel, Table 10.7, p. 47; Appendix B: Sample instructions for radiation protection after therapeutic administration of radioiodine, p. 71.
19. Dauer LT, Williamson MJ, St Germain J, Strauss HW. Tl-201 stress tests and homeland security. J Nucl Cardiol. 2007. 14(4):582–588.
20. Beasley CW, Moore WH, Wagner LK. Release instructions for hyperthyroid patients treated with I-131. Thyroid. 2011. 21(10):1163–1164. author reply 4-5.
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