The Effects of Radioiodine Treatment on Health-Related Quality of Life in Patients Treated for a Differentiated Thyroid Carcinoma: A Systematic Review and Meta-Analysis

BACKGROUND: The incidence of differentiated thyroid carcinoma (DTC) has markedly increased since the 1990s. The patients' health-related quality of life (HRQoL) is an essential outcome to consider, both short- and long-term. After thyroidectomy, treatment generally includes radioiodine therapy (RIT), the impact of which on HRQoL remains debated, particularly in patients at low risk of recurrence. This systematic review with meta-analysis aims to comprehensively evaluate the association of RIT with HRQoL in patients with DTC throughout the disease trajectory. METHODS: A systematic literature review was conducted, and the findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies published between January 2000 and June 2026. Observational studies and randomized controlled trials assessing HRQoL in patients with DTC treated with RIT were eligible for inclusion. Methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias 2 tool for randomized trials. Random-effects meta-analyses were performed when the data allowed. RESULTS: In total, 53 studies were included in the systematic review, of which 6 were included in the meta-analyses. Before the administration of RIT, patients' HRQoL was already impaired compared with that of the general population. After RIT, the onset of certain symptoms had sometimes a negative impact on HRQoL. Few months post treatment, an overall improvement in HRQoL was observed in most patients compared with baseline. More than one year post treatment, HRQoL approach is that of the general population. CONCLUSIONS: Symptoms or anxiety associated with RIT may impair HRQoL around the time of treatment. HRQoL tends to approach that of the general population, although it does not consistently reach the same level. Furthermore, some patients may continue to experience persistent symptoms whose severity depends on the dose received. The heterogeneity of the results highlights the importance of future studies using more homogeneous and thyroid-specific questionnaires, and to include analyses adjusted for confounding factors such as administered activity and preparation methods, along with a pre-surgical assessment, in order to better evaluate the specific effect of RIT on HRQoL.