Management of Challenging Radioiodine Treatment Protocols: A Case Series and Review of the Literature.

Radioactive iodine (RAI) therapy with 131I is the standard of care for treatment in many patients with differentiated thyroid cancer. Because 131I is typically administered as a pill, and much of its radioactivity is excreted via the urine, there can be challenges in patients who cannot swallow pills, absorb iodine via the gastrointestinal tract, or eliminate RAI via the urine (i.e., dialysis patients and patients with renal failure). In this article, we present 3 cases in which the standard 131I treatment protocol for thyroid cancer could not be used because of these challenges, and we discuss the strategies used to overcome them. Provider collaboration and treatment customization are critical in overcoming patient-specific challenges.