ObjectiveTo analyze the current research status of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) in the past 10 years so as to understand the research hotspots and future development in this field through a bibliometric visualization analysis. MethodsThe literature relevant DTC RAI therapy published from 2014 to 2023 was screened using the Web of Science database. The publication time, country, institution, author, keywords, and other content of literature were analyzed, and the multidimensional scientific research network was constructed, and the visualization analysis was performed using RStudio and Flourish software. ResultsA total of 2 018 studies related to DTC RAI therapy were screened out from the publications from 2014 to 2023, with a fluctuating trend of increasing publication numbers. The publication numbers in China ranked first (422 articles), followed by the United States (374 articles) and Italy (182 articles). In terms of international cooperation, the United States ranked first with the most leading collaborations (289 times), and the top 3 countries in terms of cooperation with the United States were Italy (33 times), China (21 times), and France (21 times). China ranked fifth in leading cooperation, relatively less (52 times), with the main collaborators being Japan (7 times), South Korea (6 times), and Australia (5 times). Half of the top 6 institutions in terms of publication numbers were from the United States, with the top 3 being Unicancer from France (135 articles), Memorial Sloan Kettering Cancer Center from the United States (134 articles), and the UT MD Anderson Cancer Center from the United States (89 articles). Beijing Union Medical College Hospital and Shanghai Jiao Tong University ranked 19th and 23rd, respectively, with article counts of 46 and 44 articles. Tuttle RM, an author from the United States, ranked first in both publication numbers and contribution, with a total of 48 articles published from 2014 to 2023. There were two authors, Lin YS and Tan J, from China who had made it into the top 10 in terms of publication numbers, with 32 and 25 publications, respectively. The trend topics showed the evolution of hot topics, covering from the relation between urinary iodine and DTC, lymph node metastasis, to innovative research and prognosis assessment, as well as in-depth exploration of new therapies for iodine-refractory DTC. The co-occurrence and clustering of keywords included 4 aspects, namely, the standardized management of DTC, related contents during the peri-treatment period, papillary thyroid carcinoma, and the exploration of targeted therapy for iodine-refractory DTC. ConclusionsIn recent years, the research focus in the field of DTC RAI therapy has shifted from technical applications to management concepts, which has also promoted the improvement of treatment modes and made patients’ treatment plans increasingly personalized and precise. Future research will focus on precision medicine, individualized treatment, the combination of targeted therapy and immunotherapy, resistance mechanisms to treatment, and long-term management after treatment, aiming to improve patients’ treatment outcomes and quality of life and achieve a revolutionary breakthrough in treatment.
The administration of radioactive iodine-131 (131I) is one of the representative traditional targeted therapy for post-surgical differentiated thyroid carcinoma (DTC). As DTC tumor cells largely preserve the capability of thyroid follicular epithelial cells, including the expression of the sodium iodide symporter (NIS), 131I can be selectively internalized by these cells once introduced into the body. The simultaneous emitting of both γ-ray and β-ray from 131I featured its unique theranostic value in managing DTC, through γ-ray to detect the residual thyroid tissue and DTC lesions via nuclear medical imaging, while through β-ray to yield the precise tumoricidal effect as well as remnant thyroid ablation. This theranostic potential of 131I significantly enhances progression-free survival, disease-specific survival, and overall survival in DTC patients with residual/recurrent/metastatic lesions as long as they are capable of iodine uptake. Nevertheless, the clinical application of 131I, despite its “precise” treatment philosophy, remains far from precision medicine while clinical practice, which urges further refinement in pre-treatment assessment, dosage tailoring, and post-treatment efficacy evaluation to fully capitalize on its theranostic benefits. Recently, with the accumulation of evidence-based medical data, 131I treatment has evolved with respect to treatment principles, pre-treatment risk stratification, post-treatment dynamic assessment, and comprehensive patient management, with an aim to optimize the diagnostic and therapeutic precision of 131I. Here we briefly review and update the recent advance on 131I management on DTC.
ObjectiveTo summarize recent advances in the preoperative differential diagnosis, pathological risk stratification, and standardized management of follicular thyroid carcinoma (FTC), aiming to inform clinical decision-making. MethodRecent domestic and international literature regarding the preoperative diagnosis, pathological typing, surgical strategies, radioactive iodine (RAI) therapy, and systemic treatments for FTC was comprehensively reviewed and summarized. ResultsRegarding preoperative diagnosis, the integration of neoplasm-specific ultrasound risk stratification systems, multimodal imaging, radiomics integrated with artificial intelligence models, and molecular biomarkers—including genetic profiling via tissue and liquid biopsies—demonstrates utility in refining the preoperative risk stratification of follicular thyroid neoplasms. Nevertheless, definitive diagnosis of FTC remains contingent upon histopathological examination following surgical resection. Therapeutic strategies emphasize individualized, risk-based management aligned with the 2022 WHO Classification and the 2025 American Thyroid Association Guidelines, stratifying interventions based on tumor invasiveness and vascular involvement. Thyroid lobectomy is recommended as sufficient therapy for low-risk FTC (minimally invasive, non-vascularly invasive tumors), offering a favorable prognosis while minimizing surgical morbidity. For low-to-intermediate-risk FTC (<4 sites of vascular invasion), management necessitates a personalized approach incorporating patient age, tumor dimensions, and informed patient preferences. Total thyroidectomy with adjuvant RAI therapy is advocated for high-risk patients exhibiting extensive vascular invasion (≥4 sites), significant extrathyroidal extension, or distant metastases; subsequent management is tailored based on dynamic risk stratification. Thermal ablation is not endorsed as a primary curative modality for surgically eligible candidates. For progressive, unresectable, or RAI-refractory FTC, upfront molecular profiling and multidisciplinary tumor board review are imperative. Identification of actionable drivers (e.g., BRAFV600E mutation, RET fusion, and NTRK fusion) warrants matched targeted therapies as first-line treatment. In the absence of specific targets, multikinase inhibitors such as lenvatinib or sorafenib remain the systemic therapy mainstay. ConclusionThe clinical management of FTC has gradually shifted from treatment decisions based on a single indicator to a whole-course individualized management model encompassing preoperative risk stratification, standardized surgery and pathological examination, postoperative dynamic risk stratification surveillance, with molecular subtyping and targeted therapy integrated for advanced disease.