2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer?

Abstract

Modern use of post-operative radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC) should be implemented in line with patients’ risk stratification. Although beneficial effects of radioiodine are undisputed in high-risk patients, controversy remains in intermediate-risk and some low-risk patients. Since the last consensus on post-surgical use of RAI in DTC patients, new retrospective data and results of prospective randomized trials have been published, which have allowed the development of a new European Thyroid Association (ETA) statement for the indications of post-surgical RAI therapy in DTC. Questions about which patients are candidates for RAI therapy, which activities of RAI can be used, and which modalities of pre-treatment patient preparation should be used are addressed in the present guidelines.

Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy – A German position paper from Surgery and Nuclear Medicine

“…Abstract A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1 . This publication discusses indications for RIT on the basis of an individual risk assessment.…”

“…Zusammenfassung Die European Thyroid Association (ETA) hat vor Kurzem eine Konsenserklärung zu den Indikationen für die postoperative Radiojodtherapie (RIT) bei Patienten mit differenziertem Schilddrüsenkrebs veröffentlicht 1 . In dieser Veröffentlichung werden die Indikationen für eine RIT auf der Grundlage einer individuellen Risikobewertung erörtert.…”

Prognostic Impact of Microscopic Extra-Thyroidal Extension (mETE) on Disease Free Survival in Patients with Papillary Thyroid Carcinoma (PTC)

“…French guidelines propose that mETE might be taken into account in the decision of post-operative RAI ablation, along with other adverse features [ 29 ]. Lately, the 2021 European Thyroid Association Guidelines on indications for post-surgical radioiodine therapy in differentiated thyroid cancer still consider small tumors with minimal extension as intermediate risk tumors, suggesting that the benefit of RAI therapy is controversial but should be discussed, based on post-operative thyroglobuline and neck ultrasound [ 30 ].…”

Shared Decision Making for Radioiodine Therapy and the Actual Pattern of Care in Intermediate-Risk Differentiated Thyroid Carcinoma

“…This approach was particularly useful because the classification approximates routine clinical practice; moreover, it is the method most commonly used in Europe. However, in its latest consensus paper, the ETA adopts the ATA classification (3).…”

“…There was no consensus for RAI in low-risk patients, because of uncertainties whether 131 I should be generally offered or be selectively administered. The latest ETA consensus paper, published 2021, recommends that the decision to RAI in low-risk patients should be based on the presence of individual risk modifiers; in intermediate-risk patients, it states that RAI therapy may be indicated and should be should be adapted to the individual case (3).…”