Increased Risk of Leukemia After Radioactive Iodine Therapy in Patients with Thyroid Cancer: A Nationwide, Population-Based Study in Korea

Abstract

RAIT exceeding 100 mCi was strongly associated with the development of leukemia in a nationwide, population-based study, while lower RAIT doses were not. Considering the favorable survival of patients with thyroid cancer and the potential harm of RAIT, physicians need to consider the pros and cons of RAIT when using this treatment option.

Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

“…It is also important to consider that this dose has been found safe for leukemia and other malignancies. 28 our results are in agreement with the current literature which advocates minimal intervention with regard to type of surgery and the administered dose of RAI in the management of low-risk PTC patients.…”

Low postoperative nonstimulated thyroglobulin as a criterion for the indication of low radioiodine activity in patients with papillary thyroid cancer of intermediate risk ‘with higher risk features’

“…Thus, if we consider that the patient with residual disease had been treated and that the recurrence rate would be reduced to half if the patients had received a high 131 I activity, it would still be necessary to treat approximately 30 patients with high 131 I activities to prevent one recurrence. This number seems to be high if we consider the higher risk of adverse effects after the administration of high RAI activity compared to low activity . However, we recognize that only a comparative randomized study would be able to consistently demonstrate that low and high activities of RAI are equally effective in this subgroup of patients and the advantages of the former.…”

Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis

“…This is an important point as surgery or RAI treatment in PTC is related to increased morbidity that could decrease the patient's quality of life. Hypocalcaemia, recurrent nerve injury and scarring are surgical complications of PTC, and therapeutic RAI has also been shown to cause various complications such as sialadenitis, gonadal damage and secondary cancers. From a socioeconomic perspective, the burden of thyroid cancer is increasing worldwide, and a large portion of the cost is from treatment.…”