tyrosin kinase inhibitors for nis induction in thyroid cancer

Tyrosine kinase inhibitors (TKIs) play a significant role in the management of refractory or advanced thyroid cancers, particularly differentiated thyroid cancers that are resistant to conventional treatments such as radioactive iodine (RAI) therapy. In this context, TKIs can influence the induction and interpretation of nuclear imaging studies used for disease assessment and monitoring.

TKIs, by targeting specific molecular pathways involved in thyroid cancer progression, may alter tumor biology and iodine uptake characteristics. This can impact the utility and timing of nuclear imaging modalities, such as radioactive iodine scans and other radioisotope-based imaging, which are critical for detecting residual or metastatic disease.

While UK guidelines ¹ emphasize the use of radioactive iodine for ablation and monitoring in differentiated thyroid cancer, they do not explicitly detail the role of TKIs in the induction of nuclear imaging studies. However, recent consensus recommendations and expert opinions (Do Cao et al., 2025) highlight that in refractory follicular-derived thyroid cancers, TKIs are increasingly used to control disease progression when RAI is ineffective. In such cases, nuclear imaging studies may be adapted or supplemented with alternative radiotracers or imaging techniques to evaluate treatment response and disease status under TKI therapy.

Specifically, TKIs may restore or enhance radioiodine uptake in some tumors by modulating the sodium-iodide symporter expression, thereby potentially re-inducing the utility of RAI scans in previously RAI-refractory cases (Do Cao et al., 2025). This dynamic can guide clinicians on when to perform nuclear imaging studies to assess the effectiveness of TKI therapy and to decide on subsequent treatment steps.

In summary, TKIs serve both as therapeutic agents in advanced thyroid cancer and as modulators of tumor characteristics that influence nuclear imaging strategies. Their use necessitates a tailored approach to nuclear imaging, integrating molecular response with imaging findings to optimize patient management.