High-activity radioactive iodine (RAI) therapy for metastatic thyroid cancer (TC) requires isolation to minimize radiation exposure to third parties, thus posing challenges for patients needing hands-on care. There are limited data on the approach to high-activity RAI treatment in paraplegic patients. We report a state-of-the-art multidisciplinary approach to the management of bedbound patients, covering necessary radiation safety measures that lead to radiation exposure levels as low as reasonably achievable. Given the limited literature resources on standardized approaches, we provide a practical example of the safe and successful treatment of a woman with BRAFV600E-mutant tall-cell–variant papillary TC and pulmonary metastases, who underwent dabrafenib redifferentiation before RAI therapy. The patient was 69 y old and had become paraplegic because of a motor-vehicle accident. Since caring for a paraplegic patient with neurogenic bowel and bladder dysfunction poses radiation safety challenges, a multidisciplinary team comprising endocrinologists, nuclear medicine physicians, radiation safety specialists, and the nursing department developed a radiation mitigation strategy to ensure patient and staff safety during RAI therapy. The proposed standardized approach includes thorough monitoring of radiation levels in the workplace, providing additional protective equipment for workers who handle radioactive materials or are in direct patient contact, and implementing strict guidelines for safely disposing of radioactive waste such as urine collected in lead-lined containers. This approach requires enhanced training, role preparation, and practice; use of physical therapy equipment to increase the exposure distance; and estimation of the safe exposure time for caregivers based on dosimetry. The effective and safe treatment of metastatic TC in paraplegic patients can be successfully implemented with a comprehensive radiation mitigation strategy and thorough surveying of personnel for contamination.

高活性放射性碘 (RAI) 治疗转移性甲状腺癌 (TC) 需要隔离，以尽量减少对第三方的辐射暴露，从而给需要亲自护理的患者带来了挑战。关于截瘫患者高活性 RAI 治疗方法的数据有限。我们报告了一种最先进的多学科方法来管理卧床患者，涵盖必要的辐射安全措施，使辐射暴露水平尽可能低。鉴于标准化方法的文献资源有限，我们提供了一个对患有BRAFV600E突变高细胞变异乳头状 TC 和肺转移的女性进行安全、成功治疗的实例，该女性在 RAI 治疗前接受了达拉非尼再分化。患者今年69岁，因车祸导致截瘫。由于护理患有神经源性肠道和膀胱功能障碍的截瘫患者面临辐射安全挑战，由内分泌学家、核医学医师、辐射安全专家和护理部门组成的多学科团队制定了辐射缓解策略，以确保患者和工作人员在 RAI 治疗期间的安全。拟议的标准化方法包括彻底监测工作场所的辐射水平，为处理放射性材料或直接接触患者的工人提供额外的防护设备，并实施严格的安全处置放射性废物（例如收集在铅衬里容器中的尿液）的指南。 这种方法需要加强培训、角色准备和实践；使用物理治疗设备增加接触距离；并根据剂量测定估计护理人员的安全暴露时间。通过全面的辐射缓解策略和对人员污染的彻底调查，可以成功实施截瘫患者转移性 TC 的有效和安全治疗。