ABSTRACT
Many aspects of patient management in thyroid cancers including I-131 use are based on retrospective data or expert opinions and still debatable. With the increasing use of ultrasonography, demographics of thyroid cancers started to change starting from 1990s. Most of the newly diagnosed thyroid cancers are consisting of small intrathyroidal low risk tumors. The standard and intensive treatments and screening programs which failed to show any survival benefits has started arguments of over-treatment in thyroid cancers. Individualized treatment strategies based on changing demographic of thyroid cancer resulted in recommendation of less surgery, loosened follow-up protocols and less I-131 use as well. However, the need of re-interpretation of I-131 use is not a result of decreased effectiveness of radioiodine but rather increased numbers of surgically cured patients which would not benefit from I-131 therapy. Although new approaches will not change the use of I-131 in metastatic diseases, ablative and adjuvant use of I-131 needs to be re-considered within this perspective. These review aims to discuss changing role of I-131 in light of guidelines but a wider perspective to bring proposals which could facilitate our daily practice.
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