Non-Cochrane · intervention · PM42522170
Reassessing Radioactive Iodine Use After Thyroidectomy in Low-Risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis.
Asif Maheen, Nisar Mudasar, Asif Aliza, et al. · Endocrinology, diabetes & metabolism · 2026 · PubMed · doi:10.1002/edm2.70293
Findings
Population Adults with low-risk differentiated thyroid cancer after total thyroidectomy
11 findings
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Recurrence Hospital and registry cohorts and trials | OR 0.66 [0.41, 1.08] GRADE not reported 7 studies · 4101 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Indeterminate response to treatment Hospital and registry cohorts and trials | OR 0.91 [0.46, 1.80] GRADE not reported 3 studies · 1104 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | 5-year recurrence-free survival 5 years · Hospital and registry cohorts and trials · Subgroup by study design: cohort studies | OR 4.70 [1.39, 15.97] GRADE not reported 3 studies · 2493 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Structurally incomplete response to treatment Hospital and registry cohorts and trials | OR 1.49 [0.51, 4.36] GRADE not reported 3 studies · 1104 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Elevated thyroglobulin antibodies Hospital and registry cohorts and trials | OR 0.91 [0.38, 2.16] GRADE not reported 2 studies · 1280 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Serum thyroglobulin > 1 ng/mL Hospital and registry cohorts and trials | OR 1.20 [0.00, 342.55] GRADE not reported 2 studies · 1561 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Excellent response to treatment Hospital and registry cohorts and trials | OR 1.00 [0.52, 1.92] GRADE not reported 3 studies · 1104 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Xerostomia (adverse effect) Hospital and registry cohorts and trials | OR 5.63 [0.05, 667.24] GRADE not reported 2 studies · 748 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | 5-year recurrence-free survival 5 years · Hospital and registry cohorts and trials | OR 2.47 [0.63, 9.62] GRADE not reported 4 studies · 2997 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Biochemically incomplete response to treatment Hospital and registry cohorts and trials | OR 0.54 [0.10, 2.86] GRADE not reported 3 studies · 1104 participants |
| Radioactive iodine (RAI) ablation after total thyroidectomy | No RAI (total thyroidectomy alone) | Dysphonia (adverse effect) Hospital and registry cohorts and trials | OR 0.96 [0.53, 1.72] GRADE not reported 2 studies · 748 participants |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chow 2021 Association between quality of life and patient-reported complications from surgery and radioiodine in early-stage thyroid cancer… PMID:33648765 | 2021 | 1 other review | Dysphonia (adverse effect); Xerostomia (adverse effect) | not extracted yet |
| Durante 2012 Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role… PMID:22679061 | 2012 | this review only | Recurrence; Serum thyroglobulin > 1 ng/mL | not extracted yet |
| Fatima 2024 Outcomes of Low-Risk Differentiated Thyroid Cancer (DTC) without Radioactive Iodine (RAI) Ablation Therapy Post-Thyroidectomy: An… PMID:39113518 | 2024 | this review only | Recurrence | not extracted yet |
| Ibrahimpasic 2012 Undetectable thyroglobulin after total thyroidectomy in patients with low- and intermediate-risk papillary thyroid cancer--is there a need… PMID:23158181 | 2012 | this review only | Recurrence; 5-year recurrence-free survival | not extracted yet |
| Ilera 2023 Is radioiodine ablation with 1.1 GBq (30 mCi) 131I necessary in low-risk thyroid cancer patients? Results from a long-term follow-up… PMID:36988853 | 2023 | this review only | Excellent response to treatment; Indeterminate response to treatment; Biochemically incomplete response to treatment; Structurally incomplete response to treatment | not extracted yet |
| Leboulleux 2022 Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer. PMID:35263518 | 2022 | this review only | Excellent response to treatment; Indeterminate response to treatment; Biochemically incomplete response to treatment; Structurally incomplete response to treatment; Serum thyroglobulin > 1 ng/mL; Elevated thyroglobulin antibodies | not extracted yet |
| Mallick 2025 Thyroidectomy with or without postoperative radioiodine for patients with low-risk differentiated thyroid cancer in the UK (IoN): a… PMID:40543520 | 2025 | this review only | Recurrence; Dysphonia (adverse effect); 5-year recurrence-free survival; Elevated thyroglobulin antibodies; Xerostomia (adverse effect) | not extracted yet |
| Satapathy 2023 Radioiodine versus no radioiodine outcomes in low-risk differentiated thyroid cancers: A propensity-score matched analysis. PMID:37491776 | 2023 | this review only | Recurrence; 5-year recurrence-free survival | not extracted yet |
| Súss 2017 Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without… PMID:29641738 | 2018 | this review only | Recurrence; Excellent response to treatment; Indeterminate response to treatment; Biochemically incomplete response to treatment; Structurally incomplete response to treatment | not extracted yet |
| Xu 2024 Association of Radioactive Iodine Administration With Outcome Among Patients With Low-Risk Differentiated Thyroid Cancer: A Real-World… PMID:39440519 | 2025 | this review only | Recurrence; 5-year recurrence-free survival | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Salivary and lacrimal disorders in patients treated with radioiodine for differentiated thyroid cancer. (2026) | 1 | 0.01 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Low-risk differentiated thyroid cancer (ATA 2015 definition) patients | Low-risk differentiated thyroid cancer after total thyroidectomy (n=5260; 10 studies) |
| Intervention | Radioactive iodine ablation plus total thyroidectomy | RAI ablation after total thyroidectomy (doses 30 to 115.5 mCi where reported) |
| Comparison | Total thyroidectomy alone | Total thyroidectomy without RAI |
| Outcomes | Recurrence, 5-year recurrence-free survival, response to treatment, serum thyroglobulin > 1 ng/mL, elevated thyroglobulin antibody, side effects (xerostomia, dysphonia) | Recurrence (7 studies); 5-year recurrence-free survival (4); response to treatment categories (3); serum Tg > 1 ng/mL (2); elevated TgAb (2); xerostomia (2); dysphonia (2) |
| Study designs | RCTs and observational studies, English language, peer reviewed | 2 RCTs and 8 observational studies |
| Timing | Not specified | Median follow-up about 3 to 8 years where reported |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Yes | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |