Reassessing Radioactive Iodine Use After Thyroidectomy in Low-Risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism Pub Date : 2026-07-28 DOI:10.1002/edm2.70293

Maheen Asif, Mudasar Nisar, Aliza Asif, Makzooma Batool, Rabia Javed Iqbal, Mohammed Hammad Jaber Amin

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Abstract

Background

Radioactive iodine (RAI) therapy is often administered post-total thyroidectomy in patients with low-risk differentiated thyroid carcinoma, despite guidelines advising against its routine application. Evidence regarding the efficacy of RAI in reducing recurrence and improving survival in low-risk differentiated thyroid cancer (DTC) remains inconsistent.

Methods

We conducted a systematic review and meta-analysis of observational studies and randomized clinical trials that compare RAI versus no RAI in low-risk DTC patients. Databases such as MEDLINE, Scopus, Cochrane Library, and Google Scholar were searched through December 2025. Outcomes included recurrence, recurrence-free survival, treatment response, biochemical markers, and side effects. We performed statistical analysis using Review Manager (RevMan) 5.4 with a random-effects model, reporting odds ratios (OR) with 95% confidence intervals, and significance set at p < 0.05. Heterogeneity was assessed using I² statistics.

Results

Ten studies (n = 5260) were included in the analysis. No statistically significant difference was observed between the two groups for recurrence (OR 0.66, 95% CI: 0.41–1.08; p = 0.10), 5-year recurrence-free survival (OR 2.47, 95% CI: 0.63–9.62; p = 0.19), or treatment response (excellent response: OR 1.00, 95% CI: 0.52–1.92; p = 1.00). Secondary outcomes, including serum thyroglobulin > 1 ng/mL (OR 1.20, 95% CI: 0.00–342.55; p = 0.95), elevated thyroglobulin antibodies (OR 0.91, 95% CI: 0.38–2.16; p = 0.83), xerostomia (OR 5.63, 95% CI: 0.05–667.24; p = 0.48), and dysphonia (OR 0.96, 95% CI: 0.53–1.72; p = 0.88), were also not significantly different between groups, although estimates were not precise.

Conclusion

The available randomized and observational evidence does not demonstrate a clear, clinically meaningful benefit of routine RAI ablation in patients classified as low-risk DTC. These findings should be interpreted with caution due to heterogeneity across studies, variability in outcome definitions, and the predominance of observational data.

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低风险分化甲状腺癌甲状腺切除术后放射性碘使用的再评估：一项系统回顾和荟萃分析。

背景：放射性碘（RAI）治疗常用于低风险分化甲状腺癌患者全甲状腺切除术后，尽管指南不建议常规应用。关于RAI在降低低风险分化型甲状腺癌（DTC）复发和提高生存率方面的有效性的证据仍不一致。方法：我们对观察性研究和随机临床试验进行了系统回顾和荟萃分析，比较了低风险DTC患者的RAI和无RAI。截至2025年12月，检索了MEDLINE、Scopus、Cochrane Library和谷歌Scholar等数据库。结果包括复发、无复发生存、治疗反应、生化指标和副作用。我们使用Review Manager (RevMan) 5.4进行统计分析，采用随机效应模型，报告95%置信区间的优势比（OR），显著性设置为p 2统计量。结果：10项研究（n = 5260）被纳入分析。两组在复发率（OR 0.66, 95% CI: 0.41-1.08; p = 0.10）、5年无复发生存率（OR 2.47, 95% CI: 0.63-9.62; p = 0.19）和治疗反应（极好反应：OR 1.00, 95% CI: 0.52-1.92; p = 1.00）方面均无统计学差异。次要结局，包括血清甲状腺球蛋白>.1 ng/mL （OR 1.20, 95% CI: 0.00-342.55; p = 0.95）、甲状腺球蛋白抗体升高（OR 0.91, 95% CI: 0.38-2.16; p = 0.83）、口干（OR 5.63, 95% CI: 0.05-667.24; p = 0.48）和发音障碍（OR 0.96, 95% CI: 0.53-1.72; p = 0.88），两组之间也没有显著差异，尽管估计并不精确。结论：现有的随机和观察性证据并不能证明常规RAI消融对低危DTC患者有明确的、有临床意义的益处。由于研究的异质性、结果定义的可变性和观察数据的优势，这些发现应谨慎解释。

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