Mihailović Jasna
Department of Nuclear Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia.
Division of Nuclear Medicine, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia.
Diagnostics (Basel). 2025 Jun 5;15(11):1438. doi: 10.3390/diagnostics15111438.
Therapy with radioactive iodine (I-131) following a total thyroidectomy has been a gold standard in the treatment of differentiated thyroid cancer (DTC) for over 80 years. Over the years, its role has shifted from routine use to a more selective, risk-adapted approach, informed by tumor biology, patient risk stratification and evolving clinical guidelines. This review examines the changing landscape of I-131 therapy, tracing its historical foundations, current indications, and future directions shaped by molecular medicine. We discuss the transition from a standardized, one-size-fits-all treatment approach to an individualized, dynamic stratification model that allows for ongoing risk reassessment and tailored treatment strategies. Key updates in clinical practice, such as the 2015 ATA Guidelines, the 2022 ETA Consensus Statement, and joint SNMMI and EANM nuclear medicine recommendations, are critically examined. We also address ongoing controversies in the management of low- and intermediate-risk patients, including the roles of I-131 whole-body scanning, activity selection, and overall treatment approach. Molecular theranostics is ushering in a new era in DTC management, enabling improved patient selection and more precise treatment. Advances in molecular profiling, imaging, and targeted therapies support a personalized treatment approach that aims to optimize therapeutic decisions while minimizing side effects and enhancing long-term safety.
全甲状腺切除术后采用放射性碘（I-131）治疗已成为分化型甲状腺癌（DTC）治疗80多年来的金标准。多年来，其作用已从常规使用转变为更具选择性、基于风险调整的方法，这一转变受肿瘤生物学、患者风险分层以及不断演变的临床指南的影响。本综述探讨了I-131治疗不断变化的格局，追溯其历史根源、当前适应证以及受分子医学影响的未来发展方向。我们讨论了从标准化的一刀切治疗方法向个体化动态分层模型的转变，该模型允许持续进行风险重新评估并制定量身定制的治疗策略。对临床实践中的关键更新内容，如2015年美国甲状腺协会（ATA）指南、2022年欧洲甲状腺协会（ETA）共识声明以及美国核医学与分子影像学会（SNMMI）和欧洲核医学协会（EANM）联合发布的核医学建议，进行了批判性审视。我们还讨论了低风险和中风险患者管理中持续存在的争议，包括I-131全身扫描的作用、剂量选择以及整体治疗方法。分子诊疗正在开创DTC管理的新时代，能够改善患者选择并实现更精准的治疗。分子谱分析、成像和靶向治疗方面的进展支持了一种个性化治疗方法，旨在优化治疗决策，同时将副作用降至最低并提高长期安全性。
