The use of radioiodine in the management of benign thyroid disease.

College of Physician’s guidelines on the use of radioactive iodine in hyperthyroidism. The original guidelines, produced in 1995 by a College Working Party, represented the bodies involved in the administration of radioiodine (131I).1 The need for these guidelines emerged from the outcome of a survey, reported in this Journal, which showed considerable variation within the UK in the doses of radioiodine used to treat hyperthyroidism, ranging from almost homeopathic through to doses sufficiently large to cause concern over unnecessary use of radiation.2 The original guidelines had a major impact on the way radioiodine is given, leading to more uniformity and far better information provision for patients, including formalisation of the necessity for informed consent. All guidelines require revision to ensure that they remain contemporary and since 1995 the practice has moved on, with the expectation that evidence is clearly assessed and recommendations are made according to well-established criteria. Unfortunately much of the practice with regard to radioiodine has been based on local protocols which have developed since the first use of this treatment in the 1940s. Controlled trials will never be performed in many areas of radioiodine treatment, but the last decade has seen the publication of a number of controlled trials addressing aspects which have remained controversial, and these new data can be used to produce contemporary grading with regard to the level of evidence supporting any recommendation. Recent developments