Chronotherapeutic optimization of radioactive iodine therapy in differentiated thyroid cancer: The rationale for evening administration

📖 Top 50% JournalJan 7, 2026World journal of experimental medicine

Better timing of radioactive iodine treatment for thyroid cancer: Why giving it in the evening may help

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Abstract

Aligning radioactive iodine (RAI) therapy with the peak circadian rhythm of thyroid-stimulating hormone (TSH) could enhance treatment efficacy.

The therapeutic effectiveness of RAI is dependent on the uptake facilitated by the sodium-iodide symporter (NIS), which is stimulated by TSH.
TSH levels typically peak overnight, suggesting that timing RAI administration in the evening may optimize iodine uptake.
Preclinical data indicate a connection between circadian regulation of TSH and NIS, supporting the potential benefits of evening dosing.
Implementing evening dosing may improve patient convenience and clinic workflow, though challenges exist in execution.
Current clinical validation of this approach is limited, highlighting the need for prospective studies to assess its benefits and feasibility.

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Radioactive iodine (RAI) therapy remains a cornerstone in the management of differentiated thyroid cancer (DTC). The therapeutic efficacy of RAI depends on thyroid-stimulating hormone (TSH)-driven uptakethe sodium-iodide symporter (NIS). Although elevated TSH levels are routinely achieved before RAI administration, the circadian rhythm of TSH, which peaks overnight, is largely overlooked in treatment protocols. Aligning RAI administration with this physiological peak, particularly through evening dosing, may enhance iodine uptake, improve therapeutic efficacy, and reduce systemic exposure. Preclinical data and the known circadian regulation of TSH and NIS support this approach, although clinical validation is lacking. Evening dosing may also improve patient convenience and clinic workflow. However, logistical challenges and the absence of human trials present barriers to implementation. In this narrative review, we synthesize current evidence and tentatively propose the chronotherapeutic alignment of RAI timing as a novel, potentially impactful optimization strategy in DTC management. Prospective studies are needed to evaluate its clinical benefits and feasibility. via

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