Cancer mortality after iodine‐131 therapy for hyperthyroidism
Abstract
Cancer mortality was studied in 10,552 Swedish hyperthyroid patients treated with 131 l between 1950 and 1975. The patients were matched with the Swedish Cause‐of‐Death Register and the cases of 977 patients who died from cancer or leukemia were studied. The patients had been followed up for an average of 15 years (range 0 to 35 years), and the overall standardized mortality ratio (SMR) was 1.09 [95% confidence interval (CI) = 1.03 to 1.16], with a higher risk for women. The highest mortality was seen during the first year after exposure (SMR = 1.15) and decreased for the following 9 years (SMR = 1.04). The risk of dying from a cancer in the digestive tract and respiratory organs was significantly elevated more than 10 years after exposure, as was the overall cancer mortality (SMR = 1.14). No increased risk was seen for leukemia, bladder cancer or breast cancer. Younger patients and those receiving 131 I at higher activity had higher SMRs than older patients and those receiving lower activity. Patients with toxic nodular goiter had higher risk than those with Graves' disease. The lack of increasing mortality over time and with increasing activity of 131 I administered argues against a carcinogenic effect of 131 I. However, in the case of cancers of the stomach, the 131 I exposure could have contributed to the excess mortality from these cancers.
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There is concern for thyroid malignancy following RAI therapy.
“Following RAI therapy, there have been reports of new-onset GD (up to 4% prevalence) (263) as well as concern for thyroid malignancy (254,264,265) and a very minimal increase in late nonthyroid malignancy (265).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [265]
There is a very minimal increase in late nonthyroid malignancy following RAI therapy.
“Following RAI therapy, there have been reports of new-onset GD (up to 4% prevalence) (263) as well as concern for thyroid malignancy (254,264,265) and a very minimal increase in late nonthyroid malignancy (265).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [265]
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- Authors
- Hall, P., Berg, G., Bjelkengren, G., Boice, J. D., Ericsson, U., Hallquist, A., Lidberg, M., Lundell, G., Tennvall, J., Wiklund, K., & Holm, L.
- Affiliations
- Karolinska University Hospital (SE)
- Sahlgrenska University Hospital (SE)
- Skåne University Hospital (SE)
- National Cancer Institute (US)
- University Hospital of Umeå (SE)
- Stockholm South General Hospital (SE)
- Corresponding author
- Hall, Per
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 1992-04
- Volume
- 50
- Issue
- 6
- Pages
- 886-890
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W1968700299
- Cited by
- 124
- References
- 26
- Citations by year
- 2025: 3 · 2024: 3 · 2022: 2 · 2021: 5 · 2020: 9 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 6 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01cp051034-001)
- National Cancer Institute (N01-CP-51034)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Keywords
- iodine-131 therapy, hyperthyroidism, cancer mortality, radiation-induced cancer, carcinogenicity, standardized mortality ratio, toxic nodular goiter, Graves' disease, gastric cancer, leukemia, respiratory cancer, digestive tract cancer
- MeSH terms
- Age Factors, Female, Humans, Hyperthyroidism, Iodine Radioisotopes, Leukemia, Leukemia, Radiation-Induced, Male, Middle Aged, Neoplasms, Neoplasms, Radiation-Induced, Registries, Retrospective Studies, Sweden, Time Factors
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