Empiric Radioiodine for Hyperthyroidism

Outcomes, Prescribing Patterns, and Its Place in the Modern Era of Theranostics

Emma Boehm; Yung Hsiang Kao; Jeffrey Lai; Paul R. Wraight; Dinesh A. Sivaratnam


Clin Endocrinol. 2022;97(1):124-129. 

In This Article


The traditional practice of empiric I-131 activity prescription for hyperthyroidism is generally safe, effective and feasible to co-exist with modern theranostics. For most patients, empiric prescription is a reasonable alternative to the much more resource-intensive methods of theranostically guided prescription. However, selected patients with very active disease might benefit from dedicated personalized prescription based on theranostic guidance. Although multicentre studies are truly needed to formally evaluate the added clinical benefit of theranostic prescription for these patients, it is evident that we need to be aware of our tendency toward under-prescription of I-131 activity for hyperthyroidism, and rationalize that our fear of thyrotoxic flare looms larger than the risk in reality.