Objective:

To develop and validate a risk prediction model for psychological distress in patients with differentiated thyroid cancer (DTC) undergoing ¹³¹I therapy.

Approach:

• Study Design: A total of 247 DTC patients who received ¹³¹I therapy were enrolled at a tertiary Grade A hospital in Taiyuan between May and December 2025.

Key Findings:

• Independent risk factors identified include poor sleep quality, TSH stimulation, pulmonary metastasis, social support, radiation exposure concerns, and lower serum 25-hydroxyvitamin D levels (all P < 0.05).
• The nomogram model achieved an AUC of 0.835, with sensitivity of 83.1% and specificity of 68.2%.
• Internal validation via bootstrap resampling and 10-fold cross-validation produced AUCs of 0.82 and 0.77, respectively.
• The Hosmer-Lemeshow test yielded a χ² of 12.064 (P = 0.148).

Interpretation:

The internally validated model is a promising tool for predicting psychological distress in DTC patients undergoing ¹³¹I therapy.

Limitations:

• External validation in larger, multicenter cohorts is necessary before routine clinical use can be recommended.

Conclusion:

External validation in larger, multicenter cohorts is necessary before routine clinical use can be recommended.