Treatment with radioactive iodine (131I) is the mainstay of postoperative management of differentiated thyroid carcinoma, usually administered orally as a capsule or liquid. In patients with severe dysphagia after thyroidectomy, oral administration may be contraindicated due to the risk of aspiration. It presents the case of a 37-year-old woman with BRAF V600E-mutated papillary thyroid carcinoma who developed persistent dysphagia after total thyroidectomy due to a surgical complication. The patient required long-term enteral nutrition through a gastrostomy tube and was referred for evaluation prior to 131I therapy due to the high risk of recurrence. A multidisciplinary team from nuclear medicine, endocrinology, gastroenterology, radiopharmacy and radiation safety decided to administer liquid 131I through the low-profile MIC-KEY tube according to strict protocols. Administration occurred without significant spillage or retention of radioactivity at the tube site. The report demonstrates the feasibility and safety of this approach and emphasizes the need for individualized planning and multidisciplinary collaboration in the absence of standard guidelines.