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Therapeutic radioiodine (I-131) exposure for differentiated thyroid cancer (DTC) ablation...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-IATROGENIC-IODINE131-SECONDARY-PREVENTION
TypeRed flag
Statusreviewed 2026-05-19 | pending_clinical_signoff
DiseasesDIS-BREAST
SourcesSRC-IARC-100D-IONIZING-RADIATION SRC-NCCN-BREAST-2025

Red Flag Origin

DefinitionTherapeutic radioiodine (I-131) exposure for differentiated thyroid cancer (DTC) ablation/treatment OR Graves' disease — cumulative doses ≥100 mCi (3.7 GBq) lifetime confer small-but-real increased risk of secondary malignancies. Strongest signal: leukemia (RR ~1.5-2.0 above population baseline; latency 2-10 years), salivary gland cancer (RR ~1.3-2.0; latency 5-15 years), breast cancer in females (RR ~1.2-1.4; lower-quality evidence, dose-dependent), bladder cancer (modest signal). Iodine concentrates in salivary glands + stomach + bladder during excretion; non-target dose drives secondary cancer signal. Risk modestly higher at younger ages of exposure (proliferating tissues more radiosensitive). Prevention- persona RedFlag (§20, v0.3 iatrogenic expansion).
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "any_of": [
    {
      "finding": "iodine_131_cumulative_ge_100mci",
      "value": true
    },
    {
      "finding": "i131_therapy_dtc_completed",
      "value": true
    },
    {
      "finding": "i131_therapy_graves_completed",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for I-131 therapeutic-dose lifetime cumulative exposure. Surveillance: CBC q12mo for leukemia signal (sensitivity modest); breast surveillance per general-population USPSTF unless additional risk factors; oral + salivary symptom awareness. Highest-impact preventive intervention is hydration + lemon-juice sialagogue during I-131 administration (reduces salivary gland uptake) — retrospectively non-actionable for prior exposure. STUB pending two-Co-Lead signoff per CHARTER §6.1 dev-mode.

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Indications