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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Cancer treatment

Radioactive iodine

Not all the side effects of surgery are listed here.

With any surgery, there is risk of infection, bleeding,

or pain. Your treatment team can give you a

complete list of side effects.

After surgery, you will stay in the hospital for a

couple of days and then be discharged to home. It is

important that you follow your doctor’s orders when

it comes to healing. Call your doctor or nurse if you

have any side effects, especially if they continue, get

worse, or come on suddenly.

Plan and schedule your follow-up appointments so

your doctor knows how you are feeling. He or she will

tell you when you can return to your normal activities.

Ask your doctor about your next steps of care.

Radioactive iodine

Many cancers that come from the thyroid gland

take up iodine in your body. Papillary and follicular

cancers usually “eat” iodine and use it in the cancer

cells. Thus, RAI (






odine) can be given

as treatment. The cancer cells that eat enough

radioactive iodine are killed by the radiation. This

treatment is also known as 131-I or 131-I ablation.

If this is the case, this type of treatment may be an

option. RAI is given as a treatment for papillary and

follicular thyroid cancer. RAI may not work for Hürthle

cell cancer. RAI does not work for medullary or

anaplastic thyroid cancer.

Radioactive iodine treatment will target the thyroid

cancer cells in the neck. It will also go after those

cells that have moved from the thyroid to other areas

of the body. The doses are higher with this treatment

than those given during a radioactive imaging scan.

The goal is to treat only the thyroid cells and avoid

harming your healthy tissue. RAI is usually given

after thyroid cancer surgery.

RAI is not effective to destroy the cancer without

first having a surgeon remove the thyroid gland and

cancer that can be surgically removed. Radioactive

iodine treatment is effective when used for two

reasons: 1) to get rid of any remaining thyroid tissue;

and 2) to destroy any thyroid cancer cells that remain

after surgery (adjuvant therapy).

RAI therapy comes in liquid or pill form and is taken

by mouth. You may be asked to eat a diet low in

iodine for 1 to 2 weeks before getting this treatment.

This type of treatment works best when the TSH

level is high and Tg is present. Hormone injections

may be given to increase the TSH several days

before giving RAI. This treatment is typically given

if thyroid cancer is growing beyond the thyroid, the

main tumor is more than 4 cm, and Tg is 5 to 10


RAI therapy is recommended for those at higher risk

for the cancer to come back, such as some cancers

of smaller size with extension outside the thyroid

gland (1–4 cm), or cancer in the lymph nodes. Your

doctor will gather information and decide if RAI is an

option for you. If your doctor and you decide RAI will

follow surgery, here are some side effects that may




Swollen neck



Neck pain



Nausea and vomiting



Dry mouth or eyes



Abnormal tearing



Change in taste or smell



RAI can affect both a man and woman’s

reproductive system