Radioiodine therapy in lactating women with higher-risk differentiated thyroid cancer

In selected cases, postoperative radioiodine therapy is a useful therapeutic adjunct for the treatment of differentiated thyroid cancer (DTC). Both pregnancy and breastfeeding are absolute contraindications to radioiodine therapy. However, breast uptake on scintigraphy may occur for up to 8 months after discontinuation of breastfeeding and may also less commonly occur in non-lactating women with a history of hyperprolactinemia, breast malignancy/tumor, or mastitis. Initiation of dopamine agonist therapy with either cabergoline or bromocriptine should be a consideration to decrease prolactin levels and thus shorten the length of time until it is safe to proceed with radioiodine treatment. A pretreatment diagnostic scan is necessary in women with recent cessation of lactation or history of galactorrhea to confirm that no breast uptake exists prior to administration of therapeutic I-131.