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Abstract: FR-PO256

Use of Radioactive Iodine in the Management of Thyroid Cancer in Those with Low-Clearance CKD/ESKD

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • O'Donoghue, Darragh, Cork University Hospital, Cork, Cork, Ireland
  • Clarkson, Michael, Cork University Hospital, Cork, Cork, Ireland

Radioactive iodine (RAI) is a key adjuvant treatment of differentiated thyroid cancers. Iodide is cleared by the kidney which leads to complexities in the treatment of patients with end-stage kidney disease (ESKD) due to prolonged circulation of RAI.


A structured multidisciplinary care pathway was created for those receiving RAI with ESKD, involving Nephrology, Radiation Oncology, Medical Physics, and Biomedical Engineering. A shielded room is used for RAI with the addition of mobile shielding for staff to reduce staff exposure during dialysis. Alterations for water treatment were made to deliver ultrapure water suitable for HD. Patients were dialysed in isolation until levels <30MBq (1.5μSv/hr). Safety protocols for radiation protection for staff and dialysis waste management were implemented.


Case One
47 year old man with invasive follicular thyroid carcinoma in the setting of CKD stage 4 (eGFR of 17ml/min/1.73m2). Following thyroidectomy, an avid focus present in left thyroid bed requiring treatment with RAI. He underwent radioactive iodine ablation therapy with a reduced dose protocol of 1.1 GBq. Levels were closely monitored and graphed compared to a normalised dose rate for those without renal impairment. His clearance was in line with the expected rate.
Case 2
50 year old man with recurrent papillary thyroid carcinoma on a background of ESKD on HD. Initial treatment with surgery and RAI in 2017. He represented with recurrent nodal disease and underwent a neck dissection. RAI treatment was planned.
Dialysis was arranged prior to treatment to familiarise staff with the new unit. He received a 50% reduction in RAI with a dose of 1.850 GBq. Following treatment, he underwent dialysis at 14 hours post treament then every 48 hours. His levels were reduced by >50% with each dialysis session (Figure).


RAI can be safely administered to patients with low clearance CKD/ESKD with the implementation of a structured care pathway utilising a multidisciplinary approach.