The possibility of an increased risk of cancer following radioiodine therapy for hyperthyroidism remains controversial despite numerous studies supporting the safety of RAI for this indication. A multicenter retrospective cohort study examined cancer mortality in over 35,000 patients after three treatment modalities for hyperthyroidism (56). The total number of cancer deaths was not increased for this group as a whole. Interestingly, an increased risk of cancer mortality was seen in patients treated exclusively with antithyroid drugs. Radioiodine treatment was not associated with excess total cancer deaths, or to any particular cancer, with the exception of thyroid cancer, where there was a slight increase in thyroid cancer mortality following radioiodine therapy, although the underlying thyroid disease was suggested to have played a role. Another study found that the incidence of thyroid cancer in radioiodine-treated patients over a 27-year period was not significantly different from its incidence in the general population (57). One population-based study actually found a small decrease in the risk of several types of cancer following radioiodine therapy (58). It is important to note that the number of children treated with RAI is small in the majority of these studies.
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