# Case Report: Management of a challenging case presenting with dysphagia after thyroidectomy requiring administration of liquid 131I via MIC-KEY low-profile tube—a multidisciplinary approach

## TL;DR

A 37-year-old woman with thyroid cancer and dysphagia safely received radioactive iodine therapy through a special feeding tube, showing a new approach for similar challenging cases.

## Contribution

Demonstrates a safe and feasible method for administering liquid 131I via a low-profile MIC-KEY gastrostomy tube in patients with dysphagia.

## Key findings

- Liquid 131I was successfully administered via a MIC-KEY tube without significant radioactivity spillage or retention.
- Multidisciplinary collaboration enabled safe delivery of therapy in a high-risk patient with compromised airway and dysphagia.
- The approach highlights the importance of individualized treatment planning in complex clinical scenarios.

## Abstract

Radioactive iodine (RAI) therapy with 131-iodine (131I) remains a cornerstone in the postoperative management of differentiated thyroid carcinoma (DTC). The standard route of administration is oral, typically in capsule form and less commonly as a liquid. However, in patients with severe dysphagia and compromised airway, traditional oral 131I delivery may be contraindicated due to the risk of aspiration and radioactivity contamination. These scenarios present unique clinical challenges that necessitate deviation from conventional protocols. While liquid 131I may be administered through the mouth or via nasogastric or percutaneous gastrostomy tubes, there is currently no standardized approach, and potential risks, such as radiotracer spillage or retention at the tube site, must be considered. We present the case of a 37-year-old woman with BRAF V600E-mutated papillary thyroid carcinoma (PTC) who developed persistent dysphagia following total thyroidectomy as a result of a postoperative surgical complication. She required long-term enteral feeding via a gastrostomy tube and was referred for pretherapy evaluation and assessment of the feasibility of therapeutic 131I administration in the setting of a higher risk of recurrence. Following comprehensive coordination among nuclear medicine, endocrinology, gastroenterology, radiopharmacy, and radiation safety teams, a multidisciplinary decision was made to administer liquid 131I via a low-profile MIC-KEY gastrostomy tube under stringent radiation safety protocols. Notably, no significant radioactivity was spilled or retained at the tube site, and administration was completed. Given the paucity of literature and lack of evidence-based guidelines to address such complex clinical scenarios, this report demonstrates the feasibility and safety of administering liquid 131I via a low-profile MIC-KEY gastrostomy tube and underscores the importance of individualized treatment planning and effective multidisciplinary collaboration.