Endocrinology and Metabolism

Review Article

Thyroid
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

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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.

Citations

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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

Original Article

Thyroid
Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism: Ki-Hun Kim, Juhui Lee, Chang Ho Ahn, Hyeong Won Yu, June Young Choi, Ho-Young Lee, Won Woo Lee, Jae Hoon Moon; Endocrinol Metab. 2021;36(5):1121-1130. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1216

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Abstract PDF Supplementary Material PubReader ePub

Background
Heart rate (HR) monitored by a wearable device (WD) has demonstrated its clinical feasibility for thyrotoxicosis subjects. However, the association of HR monitored by wearables with hypothyroidism has not been examined. We assessed the association between serum thyroid hormone concentration and three WD-HR parameters in hypothyroid subjects.
Methods
Forty-four subjects scheduled for radioactive iodine therapy (RAI Tx) after thyroid cancer surgery were included. Thirty subjects were prepared for RAI Tx by thyroid hormone withdrawal (hypothyroidism group) and 14 subjects by recombinant human thyrotropin (control group). Three WD-HR parameters were calculated from the HR data collected during rest, during sleep, and from 2:00 AM to 6:00 AM, respectively. We analyzed the changes in conventionally measured resting HR (On-site rHR) and WDHR parameters relative to thyroid hormone levels.
Results
Serum free thyroxine (T4) levels, On-site rHR, and WD-HR parameters were lower in the hypothyroid group than in the control group at the time of RAI Tx. WD-HR parameters also reflected minute changes in free T4 levels. A decrease in On-site rHR and WD-HR parameters by one standard deviation (On-site rHR, approximately 12 bpm; WD-HR parameters, approximately 8 bpm) was associated with a 0.2 ng/dL decrease in free T4 levels (P<0.01) and a 2-fold increase of the odds ratio of hypothyroidism (P<0.01). WD-HR parameters displayed a better goodness-of-fit measure (lower quasi-information criterion value) than On-site rHR in predicting the hypothyroidism.
Conclusion
This study identified WD-HR parameters as informative and easy-to-measure biomarkers to predict hypothyroidism.

Citations

Citations to this article as recorded by

Cost-effectiveness Analysis Comparing Conventional and Digital Software Supported Management for Hypothyroidism
Jung Hyun Kim, Jaeyong Shin, Man S Kim, Jae Hoon Moon
The Journal of Clinical Endocrinology & Metabolism.2025; 110(6): 1596. CrossRef
An explainable non-invasive hybrid machine learning framework for accurate prediction of thyroid-stimulating hormone levels
Areej Mohammed, Hussam Alshraideh, Munir Abu-Helalah, Abdulrahim Shamayleh
Computers in Biology and Medicine.2025; 189: 109974. CrossRef
Application progress of artificial intelligence in managing thyroid disease
Qing Lu, Yu Wu, Jing Chang, Li Zhang, Qing Lv, Hui Sun
Frontiers in Endocrinology.2025;[Epub] CrossRef
A Digital Software Support Platform for Hyperthyroidism Management in South Korea: Markov Simulation Model-Based Cost-Effectiveness Analysis
Jung Hyun Kim, Jaeyong Shin, Man S Kim, Jae Hoon Moon
JMIR mHealth and uHealth.2025; 13: e56738. CrossRef
Application of wearables for remote monitoring of oncology patients: A scoping review
Katharina Cloß, Marlo Verket, Dirk Müller-Wieland, Nikolaus Marx, Katharina Schuett, Edgar Jost, Martina Crysandt, Fabian Beier, Tim H Brümmendorf, Guido Kobbe, Julia Brandts, Malte Jacobsen
DIGITAL HEALTH.2024;[Epub] CrossRef
Association between resting heart rate and low natural killer cell activity: a cross-sectional study
Hyoju Oh, A-Ra Cho, Joo-Hwan Jeon, Eunkyung Suh, Junhyung Moon, Baek Hwan Cho, Yun-Kyong Lee
Frontiers in Immunology.2024;[Epub] CrossRef
Thyroid hormone action during GABAergic neuron maturation: The quest for mechanisms
Sabine Richard, Juan Ren, Frédéric Flamant
Frontiers in Endocrinology.2023;[Epub] CrossRef
A machine learning-assisted system to predict thyrotoxicosis using patients’ heart rate monitoring data: a retrospective cohort study
Kyubo Shin, Jongchan Kim, Jaemin Park, Tae Jung Oh, Sung Hye Kong, Chang Ho Ahn, Joon Ho Moon, Min Joo Kim, Jae Hoon Moon
Scientific Reports.2023;[Epub] CrossRef

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