Reassessing Radioactive Iodine Use After Thyroidectomy in Low‐Risk Differentiated Thyroid Cancer: A Systematic Review and Meta‐Analysis

Background Radioactive iodine (RAI) therapy is often administered post‐total thyroidectomy in patients with low‐risk differentiated thyroid carcinoma, despite guidelines advising against its routine application. Evidence regarding the efficacy of RAI in reducing recurrence and improving survival in low‐risk differentiated thyroid cancer (DTC) remains inconsistent. Methods We conducted a systematic review and meta‐analysis of observational studies and randomized clinical trials that compare RAI versus no RAI in low‐risk DTC patients. Databases such as MEDLINE, Scopus, Cochrane Library, and Google Scholar were searched through December 2025. Outcomes included recurrence, recurrence‐free survival, treatment response, biochemical markers, and side effects. We performed statistical analysis using Review Manager (RevMan) 5.4 with a random‐effects model, reporting odds ratios (OR) with 95% confidence intervals, and significance set at p < 0.05. Heterogeneity was assessed using I 2 statistics. Results Ten studies ( n = 5260) were included in the analysis. No statistically significant difference was observed between the two groups for recurrence (OR 0.66, 95% CI: 0.41–1.08; p = 0.10), 5‐year recurrence‐free survival (OR 2.47, 95% CI: 0.63–9.62; p = 0.19), or treatment response (excellent response: OR 1.00, 95% CI: 0.52–1.92; p = 1.00). Secondary outcomes, including serum thyroglobulin > 1 ng/mL (OR 1.20, 95% CI: 0.00–342.55; p = 0.95), elevated thyroglobulin antibodies (OR 0.91, 95% CI: 0.38–2.16; p = 0.83), xerostomia (OR 5.63, 95% CI: 0.05–667.24; p = 0.48), and dysphonia (OR 0.96, 95% CI: 0.53–1.72; p = 0.88), were also not significantly different between groups, although estimates were not precise. Conclusion The available randomized and observational evidence does not demonstrate a clear, clinically meaningful benefit of routine RAI ablation in patients classified as low‐risk DTC. These findings should be interpreted with caution due to heterogeneity across studies, variability in outcome definitions, and the predominance of observational data.