Radioiodine ablation in a haemodialysis-dependent patient with papillary thyroid carcinoma

Summary: The management of differentiated thyroid cancer with radioactive iodine (RAI) in patients with end-stage renal disease (ESRD) on haemodialysis is particularly challenging because of impaired iodine clearance, prolonged radiation exposure and safety concerns for healthcare personnel. We present the case of a 54-year-old male on thrice-weekly maintenance haemodialysis who was incidentally diagnosed with papillary thyroid carcinoma during pre-transplant assessment. He underwent total thyroidectomy followed by adjuvant RAI ablation, planned on the basis of the available literature. A reduced dose of 50 mCi (1.85 GBq) was administered after stimulation with recombinant human TSH, and dialysis was scheduled at 48 h post-therapy to optimize uptake, with additional sessions on Days +3 and +6. Ablation was successful, with iodine-avid tissue seen on post-therapy imaging and no significant complications observed. This case demonstrates that with individualized dosing, tailored dialysis scheduling and multidisciplinary coordination, RAI ablation can be performed safely and effectively in patients with ESRD on haemodialysis, despite the absence of standardized guidelines. Learning points: A reduced radioactive iodine (RAI) dose can achieve successful ablation in dialysis-dependent patients, minimizing systemic radiation exposure and marrow toxicity without compromising efficacy. The timing of the first haemodialysis session after RAI administration is critical to ensure effective thyroidal ablation while minimizing radiation toxicity. There are no standardized guidelines for RAI ablation in end-stage renal disease (ESRD) patients on haemodialysis, necessitating case-by-case multidisciplinary planning.