Iodine I-131 With or Without Selumetinib in Treating Patients With Recurrent or Metastatic Thyroid Cancer

Inclusion Criteria

• Diagnosis of recurrent and/or metastatic thyroid cancer
• Histological or cytological confirmation of thyroid carcinoma of follicular origin (including papillary, follicular, or poorly differentiated subtypes and their respective variants); NOTE: medullary and anaplastic thyroid cancers are excluded; Hurthle cell carcinomas are excluded (defined as having an invasive tumor composed of > 75% oncocytic [Hurthle] cells lacking the nuclear features of papillary carcinoma, tumor necrosis, and marked mitotic activity); patients with oncocytic (Hurthle cell) variants of papillary thyroid carcinoma (defined as a tumor composed of a majority of oncocytic [Hurthle] cells having the nuclear features of papillary carcinoma) are eligible to participate
• RAI-avid lesion on a radioiodine scan (a diagnostic, post-therapy, or post-ablation scans) performed = = 1 cm in the long axis,
• It is pathologically proven to be involved with thyroid cancer (by cytology or pathology) and it measures >= 1 cm in the long axis, or
• Its short axis is >= 1.5 cm when assessed by computed tomography (CT) scan NOTE 2: Patients only with biochemical evidence of disease without structural evidence of cancer are not eligible for this study
• For patients with non-measurable, structural disease the following must apply:
• Undetectable thyroglobulin antibody AND
• A serum thyroglobulin of 10 ng/ml or greater in the context of suppressed thyroid-stimulating hormone (TSH) (TSH = = 1500/mm^3 (obtained = = 100,000/mm^3 (obtained = 9.0 g/dL (obtained = = 50 ml/min by either the Cockcroft-Gault formula or 24-hours urine collection analysis (obtained = 800 mCi (excluding 131I activity administered for diagnostic scans)
• Treatment with chemotherapy or targeted therapy (e.g. tyrosine kinase inhibitor) = Common Terminology Criteria for Adverse Events (CTCAE) grade 2 from previous anti-cancer therapy, except for alopecia
• Cardiac conditions as follows:
• Uncontrolled hypertension (blood pressure [BP] >=150/95 mmHg despite medical therapy)
• Left ventricular ejection fraction 100 beats per minute (bpm) on electrocardiogram (ECG) at rest
• Symptomatic heart failure (New York Heart Association [NYHA] grade II-IV)
• Prior or current cardiomyopathy
• Severe valvular heart disease
• Uncontrolled angina (Canadian Cardiovascular Society grade II-IV despite medical therapy)
• Acute coronary syndrome = 21 mmHg, or uncontrolled glaucoma (irrespective of intra-ocular pressure)
• Current or past history of central serous retinopathy or retinal vein occlusion
• Symptomatic or untreated leptomeningeal disease, brain metastasis, or spinal cord compression
• Unable to follow a low iodine diet or requiring medication with high content in iodide (e.g., amiodarone)
• Received iodinated intravenous contrast within =< 2 months of registration; avoidance of iodinated oral contrast is also preferred but not strictly required for study enrollment; NOTE: those who have had iodinated intravenous contrast within this time frame may still be eligible if a urinary iodine analysis reveals that excess iodine has been cleared (defined as urinary iodine documented to be < 300 mcg/day by either a spot urinary iodine or 24-hour urinary iodine measurement)
• Any of the following:
• Pregnant women
• Nursing women
• Men or women of childbearing potential who are unwilling to employ adequate contraception
• Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy; NOTE: patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
• Uncontrolled intercurrent illness incl