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- 2025 Korean Thyroid Association Management Guidelines for Radioactive Iodine Therapy in Patients with Hyperthyroidism
- Kyeong Jin Kim, Eyun Song, Mijin Kim, Hyemi Kwon, Eu Jeong Ku, Hyun Woo Kwon, Jee Hee Yoon, Eun Kyung Lee, Won Woo Lee, Young Joo Park, Dong-Jun Lim, Sun Wook Kim, Ho-Cheol Kang, Jae Hoon Chung, Tae Yong Kim, Sin Gon Kim, Dong Gyu Na, Jee Soo Kim
- Endocrinol Metab. 2025;40(3):342-356. Published online June 24, 2025
- DOI: https://doi.org/10.3803/EnM.2025.2464
- 10,408 View
- 377 Download
- 1 Web of Science
- 1 Crossref
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Abstract
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PubReader 
ePub - Hyperthyroidism is a condition marked by excessive thyroid hormone production, most commonly due to Graves’ disease. Treatment options include antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and thyroidectomy. To develop standardized clinical recommendations for RAI therapy with a focus on safety, efficacy, and monitoring, the Korean Thyroid Association formed a task force to create evidence-based guidelines. Six key clinical questions were identified through expert consensus, and a systematic literature review from 2013 to 2022 was conducted. Clinical indications for RAI therapy were categorized into three groups: strongly recommended, may be considered, and not recommended. A fixed dose of 10 to 15 mCi is recommended. Although a strict low-iodine diet is unnecessary, iodine-rich foods should be avoided for at least 1 week before treatment. ATD should be stopped 3 to 7 days before RAI and may be resumed in select cases. Prophylactic glucocorticoids are recommended for patients with mildly active thyroid eye disease and may be considered for others at risk. Thyroid function should be monitored at 4–6 weeks post-treatment, every 2–3 months until stabilized, and then every 6–12 months. These guidelines highlight recent advances and underscore the importance of individualized treatment based on clinical features, comorbidities, and patient preferences in Korea.
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Citations
Citations to this article as recorded by
- Outcome of MRI-Guided Single-Dose Iodine-131 for Graves’ Hyperthyroidism with Large Goiter
Shangcheng Yan, Xiansheng Chen, Bing Yan, Xin Li, Zhen Cao, Pan Zhang, Yajun Wang, Wenmei Guo, Ziwen Liu
Annals of Nuclear Medicine.2026;[Epub] CrossRef
- Outcome of MRI-Guided Single-Dose Iodine-131 for Graves’ Hyperthyroidism with Large Goiter
- Thyroid
- 2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
- Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shinje Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyong Yeun Jung, Chan Kwon Jung, Yoon Young Cho, Dong-Jun Lim, Sun Wook Kim, Young Joo Park, Dong Gyu Na, Jee Soo Kim
- Endocrinol Metab. 2025;40(3):307-341. Published online June 24, 2025
- DOI: https://doi.org/10.3803/EnM.2025.2461
- 10,045 View
- 451 Download
- 5 Web of Science
- 5 Crossref
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Abstract
PDFPubReader ePub
- The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns regarding overtreatment. For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To facilitate the implementation of AS, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended for adults with pathologically confirmed Bethesda V–VI PTMC who have no clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, invasion of the trachea or recurrent laryngeal nerve, or aggressive histology. A baseline assessment requires high-resolution neck ultrasound performed by experienced operators to exclude extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis; contrast-enhanced neck computed tomography is optional. Patient characteristics, including age, comorbidities, and the capacity for long-term follow-up, should be thoroughly assessed. Shared decision-making should carefully weigh the benefits and risks of surgery versus AS, considering expected oncologic outcomes, potential complications, quality of life, anxiety, medical costs, and patient preference. Follow-up involves neck ultrasound and thyroid function tests every 6 months for 2 years and annually thereafter. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline provides a structured framework to ensure oncologic safety and supports patient-centered AS.
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Citations
Citations to this article as recorded by- Feasibility and Safety of Active Surveillance in Subcapsular Thyroid Nodules with High Suspicion for Malignancy
Yan Hu, Wei Zhou, Lu Zhang, Weiwei Zhan
Ultrasound in Medicine & Biology.2026; 52(4): 816. CrossRef - Combined Ultrasound and MRI Assessment in Patients Undergoing Reoperation for Recurrent Papillary Thyroid Carcinoma: Oncological Outcomes and Surgical Safety
Zimei Tang, Jie Liu, Rong Wang, Gang Tian, Anwen Ren, Jiexiao Li, Yiran Wang, Wen Yang, Peng Sun, Tao Huang, Ximeng Zhang, Jie Ming
Current Oncology.2026; 33(2): 98. CrossRef - Multidisciplinary team diagnosis and treatment of well-differentiated thyroid carcinoma: current landscape and future prospects
Yuanyuan Li, Peijie Wang, Jiaxin Cao, Haiyan Liu
The Oncologist.2026;[Epub] CrossRef - Optimal cutoff value of fine-needle aspiration thyroglobulin of metastatic lymph node in thyroid cancer patients
Yang Yang, Xianfeng Jiang
European Journal of Surgical Oncology.2025; 51(11): 110428. CrossRef - Low-risk thyroid cancer: surgery or active surveillance—an application of shared decision-making: a narrative review
Min Joo Kim, Eun Kyung Lee, Sun Wook Cho, Yoo Hyung Kim, Kyu Eun Lee, Su-jin Kim, Woochul Kim, Eun-Jae Chung, Jungirl Seok, Yul Hwangbo, Young Ki Lee, Jinsun Jang, Junsun Ryu, Yuh-Seog Jung, Chang Hwan Ryu, Jae Hoon Moon, June Young Choi, Hyeong Won Yu, K
Journal of the Korean Medical Association.2025; 68(9): 573. CrossRef
- Feasibility and Safety of Active Surveillance in Subcapsular Thyroid Nodules with High Suspicion for Malignancy
Original Article
- Thyroid
- Frequency of TERT Promoter Mutations in Real-World Analysis of 2,092 Thyroid Carcinoma Patients
- Heera Yang, Hyunju Park, Hyun Jin Ryu, Jung Heo, Jung-Sun Kim, Young Lyun Oh, Jun-Ho Choe, Jung Han Kim, Jee Soo Kim, Hye Won Jang, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung
- Endocrinol Metab. 2022;37(4):652-663. Published online July 22, 2022
- DOI: https://doi.org/10.3803/EnM.2022.1477
- 10,581 View
- 269 Download
- 35 Web of Science
- 38 Crossref
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Abstract
PDF
Supplementary MaterialPubReader ePub - Background
Telomerase reverse transcriptase (TERT) promoter mutations are associated with increased recurrence and mortality in patients with thyroid carcinoma. Previous studies on TERT promoter mutations were retrospectively conducted on a limited number of patients.
Methods
We prospectively collected data on all consecutive patients who underwent thyroid carcinoma surgery between January 2019 and December 2020 at the Samsung Medical Center, Seoul, Korea. We included 2,092 patients with thyroid carcinoma.
Results
Of 2,092 patients, 72 patients (3.4%) had TERT promoter mutations. However, the frequency of TERT promoter mutations was 0.5% in papillary thyroid microcarcinoma (PTMC) ≤1 cm and it was 5.8% in papillary thyroid carcinoma (PTC) >1 cm. The frequency of TERT promoter mutations was significantly associated with older age at diagnosis (odds ratio [OR], 1.12; P<0.001), larger primary tumor size (OR, 2.02; P<0.001), and aggressive histological type (OR, 7.78 in follicular thyroid carcinoma; OR, 10.33 in poorly differentiated thyroid carcinoma; OR, 45.92 in anaplastic thyroid carcinoma; P<0.001). Advanced T stage, advanced N stage, and distant metastasis at diagnosis were highly prevalent in mutated thyroid cancers. However, initial distant metastasis was not present in patients with TERT promoter mutations in PTMC. Although the C228T mutation was more highly detected than the C250T mutation (64 cases vs. 7 cases), there were no significant clinicopathological differences.
Conclusion
This study is the first attempt to investigate the frequency of TERT promoter mutations in a real-world setting. The frequency of TERT promoter mutations in PTC was lower than expected, and in PTMC, young patients, and female patients, the frequency was very low. -
Citations
Citations to this article as recorded by- Frequent BRAF V600E and TERT promoter‐mutated renal epithelial‐predominant Wilms tumours with metanephric features: a distinct subset within the Wilms tumour spectrum?
Yuemei Xu, Qiuyuan Xia, Xiaotong Wang, Ru Fang, Qi Tong, Ya Wang, Jin Chen, Jieyu Chen, Yao Fu, Jiong Shi, Qiu Rao
Histopathology.2026; 88(3): 683. CrossRef -
DDX21 Links
BRAF
V600E
and TERT to Promote Thyroid Cancer Progression
Mengke Chen, Ke Jiang, Qi Zhang, Xi Xiao, Lefan Zhu, Ye Sang, Guanghui Hu, Shuang Yu, Shubin Hong, Weiming Lv, Haipeng Xiao, Rengyun Liu
Thyroid®.2026;[Epub] CrossRef - Detection of TERT Promoter Mutations in Papillary Thyroid Carcinoma Using Droplet Digital PCR and Their Association with Aggressive Tumor Features
Jeongmin Lee, Chaiho Jeong, Jeonghoon Ha, Dong-Jun Lim, Tae-Jung Kim, Ki-Hyun Baek
International Journal of Molecular Sciences.2026; 27(3): 1497. CrossRef - Leveraging the transcriptome-phenotype relationship to guide clinical management of papillary thyroid cancer
Adrian Harvey, Eric Walser, Rebecca Lahamm-Andraos, Caitlin Yeo, Samantha Wolfe, Cynthia Stretch, Steven Craig, Oliver F. Bathe
Frontiers in Endocrinology.2026;[Epub] CrossRef - Prognostication with Thyroid GuidePx in the context of tall cell variants
Steven Craig, Cynthia Stretch, Caitlin Yeo, Jeremy Fan, Haley Pedersen, Young Joo Park, Adrian Harvey, Oliver F. Bathe
Surgery.2025; 177: 108882. CrossRef - Prognostic impact of fibrosclerotic changes in non-papillary, non-anaplastic, follicular cell-derived thyroid carcinomas
Giulia Orlando, Giulia Capella, Giulia Vocino Trucco, Elena Vissio, Jasna Metovic, Francesca Maletta, Marco Volante, Mauro Papotti
Virchows Archiv.2025; 487(3): 701. CrossRef - Telomeres and telomerase in mesothelioma: Pathophysiology, biomarkers and emerging therapeutic strategies (Review)
Dimitrios Andreikos, Demetrios Spandidos, Vasiliki Georgakopoulou
International Journal of Oncology.2025;[Epub] CrossRef - The Influence of Glycolytic Enzyme Expression on the Aggressiveness of Papillary Thyroid Carcinoma Using TCGA Data
Won Woong Kim, Daham Kim, Jin Kyong Kim, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung
Journal of Endocrine Surgery.2025; 25(1): 13. CrossRef - Allele frequency in thyroid cancer: mechanisms, challenges, and applications in cancer therapy
Jiayu Huang, Jiazhi Wang, Guangzhi Wang, Yongfu Zhao
Thyroid Research.2025;[Epub] CrossRef - The immortality mechanism of TERT promoter mutant cancers is self-reinforcing and reversible
Nicholas O. Stevers, Somang Kim, Jimmy Bo Yuan, Carter J. Barger, Chibo Hong, Olivia Lenzo, Andrew M. McKinney, Samuel H. Wu, Yu Jin Lee, Darwin W. Kwok, Abigail K. Suwala, Christina L. Appin, John D. Gordan, Annette M. Molinaro, Jun S. Song, Joseph F. Co
Molecular Cell.2025; 85(12): 2337. CrossRef - Exploring the role of TERT in thyroid Cancer: A systematic review
Thais Maloberti, Andrea Repaci, Laura Poppi, Floriana Jessica Di Paola, Giulia Calafato, Sara Coluccelli, Francesca Carosi, Alessandra Colapinto, Simone Colombero, Giacomo Credi, Giovanni Tallini, Maria A. Pantaleo, Margherita Nannini, Dario de Biase
Critical Reviews in Oncology/Hematology.2025; 213: 104792. CrossRef - Molecular Diagnosis of Thyroid Nodules Using Next‐Generation Sequencing in the Chinese Population
Hui Chen, Wei Liu, Yan Chen, Zhengzeng Jiang, Yuanyuan Ren, Jiajia Wu, Rui Liu, Min Zhu, Hongfeng Zhang, Yuan Ji, Suraiya Saleem
International Journal of Endocrinology.2025;[Epub] CrossRef - 2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shin Je Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyo
International Journal of Thyroidology.2025; 18(1): 30. CrossRef - Clonal Hematopoiesis Prevalence Years Before a Thyroid Cancer Diagnosis: A Case-Control Study
Paloma L. Cabral, Nikhila Aimalla, Kyle Shoger, John R. Caskey, Luke Zurbriggen, Neepa Shah, Ahmad Basharat, Luke F. Moat, Erica Reinig, Kristin Long, Paola Pozzo, Terrie Kitchner, Jens Eickhoff, Tonia C. Carter, Jane E. Churpek
JCO Precision Oncology.2025;[Epub] CrossRef - The effect of glycolytic enzyme expression and thyroiditis on the aggressiveness of papillary thyroid carcinoma: a retrospective cohort study
Won Woong Kim, Daham Kim, Jin Kyong Kim, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung
Annals of Surgical Treatment and Research.2025; 109(3): 169. CrossRef - Prognostic significance of BRAF V600E and TERT promoter mutations in radioiodine resistance and recurrence of differentiated thyroid cancer
Le Thi Tuyet Nhung, Nghiem Xuan Hoan, Dao Phuong Giang, Dang Trung Dung, Nguyen Thi Phuong, Ngo Thi Minh Hanh, Le Van Khanh, Ngo Thu Hang, Le Ngoc Ha, Hoang Van Tong
Medicine.2025; 104(38): e44540. CrossRef - Disease-Specific and Histological Outcomes of Preoperative TERT Promoter Mutation Detected in Isolation or in Combination with Other Mutations in Thyroid Neoplasms
Michael Calcaterra, Alaa Sada, Esra Karslioglu-French, Elena M. Morariu, Kelly L. McCoy, Kimberly M. Ramonell, Saba Kurtom, N. Paul Ohori, Simion I. Chiosea, Raja R. Seethala, Sally E. Carty, Marina N. Nikiforova, Yuri E. Nikiforov, Linwah Yip
Thyroid®.2025; 35(10): 1138. CrossRef - Evaluation of BRAF V600E and TERT mutation analysis in differential thyroid cancers
Nigar Aktash, Ahmet Cem Dural, Husnu Aydin, Nuri Alper Sahbaz, Deniz Guzey, Serdar Altınay, Cevher Akarsu, Yasir Musa Kesgin, Sezer Bulut, Mehmet Karabulut
Updates in Surgery.2025;[Epub] CrossRef -
TERT Promoter Mutations Frequency Across Race, Sex, and Cancer Type
Talal El Zarif, Marc Machaalani, Rashad Nawfal, Amin H Nassar, Wanling Xie, Toni K Choueiri, Mark Pomerantz
The Oncologist.2024; 29(1): 8. CrossRef - Gene mutations as predictors of central lymph mode metastasis in cN0 PTC: A meta‐analysis
Jiaqi Ji, Xinlong Shi
Clinical Genetics.2024; 105(2): 130. CrossRef - Risk stratification by combining common genetic mutations and TERT promoter methylation in papillary thyroid cancer
Ye Sang, Guanghui Hu, Junyu Xue, Mengke Chen, Shubin Hong, Rengyun Liu
Endocrine.2024; 85(1): 304. CrossRef - Shortened telomere length in peripheral blood leukocytes is associated with cumulative radioactive iodine doses in patients with differentiated thyroid carcinoma
Hoonsung Choi, Sun Wook Cho, Hwan Hee Kim, Ka Hee Yi, Do Joon Park, Young Joo Park
Cancer.2024; 130(12): 2215. CrossRef - 2023 Update of the Korean Thyroid Association Guidelines for the Management of Thyroid Nodules
Eun Kyung Lee, Young Joo Park
Clinical Thyroidology®.2024; 36(4): 153. CrossRef - Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 5. Evaluation of Recurrence Risk Postoperatively and Initial Risk Stratification in Different
Eun Kyung Lee, Young Shin Song, Ho-Cheol Kang, Sun Wook Kim, Dong Gyu Na, Shin Je Moon, Dong-Jun Lim, Kyong Yeun Jung, Yun Jae Chung, Chan Kwon Jung, Young Joo Park
International Journal of Thyroidology.2024; 17(1): 68. CrossRef - Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules 2024
Young Joo Park, Eun Kyung Lee, Young Shin Song, Su Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung,
International Journal of Thyroidology.2024; 17(1): 208. CrossRef - Predictive biomarkers in thyroid cancer in the current molecular-morphology paradigm
Humberto Carvalho Carneiro, Rodrigo de Andrade Natal, Evelin Cavalcante Farias, Aline Almeida Bastos, Leila Guastapaglia, Alanna Mara Pinheiro Sobreira Bezerra, Ana Amélia Fialho de Oliveira Hoff
Surgical and Experimental Pathology.2024;[Epub] CrossRef - Catching the Silent Culprits: TERT Promoter Mutation Screening of Minimally Invasive Follicular and Oncocytic Thyroid Carcinoma in Clinical Practice
L. Samuel Hellgren, Adam Stenman, Kenbugul Jatta, Vincenzo Condello, Catharina Larsson, Jan Zedenius, C. Christofer Juhlin
Endocrine Pathology.2024; 35(4): 411. CrossRef - Association Between Gross Features and Coexistence of BRAFV600E and TERT Promoter Mutations in Papillary Thyroid Carcinomas: A Combined Analysis Incorporating Clinicopathologic Features
Thi Ngoc Anh Nguyen, Van Phu Thang Nguyen, Hirokazu Kurohama, Yuko Akazawa, Katsuya Matsuda, Zhanna Mussazhanova, Yuki Matsuoka, Kenichi Yokota, Shinya Satoh, Hiroyuki Yamashita, Thi Nhung Nguyen, Yerkerzhan Sailaubekova, Masahiro Nakashima
Thyroid®.2024; 34(12): 1476. CrossRef - Are TERT Promoter Mutations a Poor Prognostic Factor in Anaplastic Thyroid Carcinoma?
Hyun Jin Ryu, Young Lyun Oh, Jung Heo, Hyunju Park, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung
International Journal of Thyroidology.2024; 17(2): 286. CrossRef - A Machine Learning-Based Model for Preoperative Assessment and Malignancy Prediction in Patients with Atypia of Undetermined Significance Thyroid Nodules
Gilseong Moon, Jae Hyun Park, Taesic Lee, Jong Ho Yoon
Journal of Clinical Medicine.2024; 13(24): 7769. CrossRef - Deciphering the Functions of Telomerase Reverse Transcriptase in Head and Neck Cancer
Tsung-Jang Yeh, Chi-Wen Luo, Jeng-Shiun Du, Chien-Tzu Huang, Min-Hung Wang, Tzer-Ming Chuang, Yuh-Ching Gau, Shih-Feng Cho, Yi-Chang Liu, Hui-Hua Hsiao, Li-Tzong Chen, Mei-Ren Pan, Hui-Ching Wang, Sin-Hua Moi
Biomedicines.2023; 11(3): 691. CrossRef - 2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
Young Joo Park, Eun Kyung Lee, Young Shin Song, Soo Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung
International Journal of Thyroidology.2023; 16(1): 1. CrossRef - Thyroid Cancer, Iodine, and Gene Mutation
Jae Hoon Chung
International Journal of Thyroidology.2023; 16(1): 89. CrossRef - Mortality rate and causes of death in papillary thyroid microcarcinoma
Jung Heo, Hyun Jin Ryu, Hyunju Park, Tae Hyuk Kim, Sun Wook Kim, Young Lyun Oh, Jae Hoon Chung
Endocrine.2023; 83(3): 671. CrossRef - TERT promoter mutations in thyroid cancer
Michiko Matsuse, Norisato Mitsutake
Endocrine Journal.2023; 70(11): 1035. CrossRef - TERT Promoter and BRAF V600E Mutations in Papillary Thyroid Cancer: A Single-Institution Experience in Korea
Min Jhi Kim, Jin Kyong Kim, Gi Jeong Kim, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Woong Youn Chung, Daham Kim, Kee-Hyun Nam
Cancers.2022; 14(19): 4928. CrossRef - Frequency of TERT Promoter Mutations in Real-World Analysis of 2,092 Thyroid Carcinoma Patients (Endocrinol Metab 2022;37:652-63, Heera Yang et al.)
Hyunju Park, Jae Hoon Chung
Endocrinology and Metabolism.2022; 37(6): 949. CrossRef - Frequency of TERT Promoter Mutations in Real-World Analysis of 2,092 Thyroid Carcinoma Patients (Endocrinol Metab 2022;37:652-63, Heera Yang et al.)
Sue Youn Kim, Chan Kwon Jung
Endocrinology and Metabolism.2022; 37(6): 947. CrossRef
- Frequent BRAF V600E and TERT promoter‐mutated renal epithelial‐predominant Wilms tumours with metanephric features: a distinct subset within the Wilms tumour spectrum?
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