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Treatment with radioactive iodine (¹³¹I) may be necessary for thyroid cancer or for hyperthyroidism in patients with end-stage renal disease who require hemodialysis. Because ¹³¹I is cleared mainly by the kidneys in patients with normal renal function, many issues arise in patients who require ¹³¹I treatment but who are on hemodialysis. This paper presents a case report of a patient on dialysis who required treatment with ¹³¹I for thyroid cancer. We describe a mathematical model, which suggests that the treatment dose of ¹³¹I for a patient with thyroid cancer on hemodialysis would be approximately 13%–28% of a typical empiric dose of ¹³¹I for a patient with normal renal function. Also, we present a comprehensive review and discussion of the literature on patients who are receiving hemodialysis who were treated with ¹³¹I for either thyroid cancer or hyperthyroidism. Using a multidisciplinary approach and special precautions, ¹³¹I therapy can be administered safely and effectively for patients with thyroid cancer or hyperthyroidism who are receiving hemodialysis.