Postoperative radioactive iodine administration for differentiated thyroid cancer patients

Lepoutre-Lussey, Charlotte; Deandreis, Désirèe; Leboulleux, Sophie; Schlumberger, Martin

doi:10.1097/med.0000000000000100

Cited by 19 publications

(43 citation statements)

References 54 publications

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“…This observation is supported by the fact that this recommendation is considered a "weak recommendation" and "low-quality evidence" (1). In agreement, in the absence of any clinical contraindication, ETA (2) and other authors (3,4) also consider THW the most indicated preparation for patients with macroscopic LN metastases.…”

Section: Introductionsupporting

confidence: 63%

Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

Rosário

Mourão

Calsolari

2017

Arch. Endocrinol. Metab.

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Objective To compare the short- and long-term outcomes of adjuvant therapy with radioactive iodine (RAI) preceded by the administration of recombinant human TSH (rhTSH) versus thyroid hormone withdrawal (THW) in patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central neck compartment (cN1b). Subjects and methods The sample consisted of 178 cN1b patients at intermediate risk who underwent total thyroidectomy with apparently complete tumor resection [including postoperative ultrasonography (US) without anomalies] and who received adjuvant therapy with RAI (30-100 mCi) preceded by the administration of rhTSH (n = 91) or THW (n = 87). Results One year after RAI, the rates of excellent response to therapy, i.e., nonstimulated thyroglobulin (Tg) ≤ 0.2 ng/mL with negative antithyroglobulin antibodies and negative neck US, and of structural disease were similar for the two preparations (84% and 4.5%, respectively, in both groups). During follow-up (median 66 months), the rate of structural or biochemical (nonstimulated Tg > 1 ng/mL, with increment) recurrence was also similar in the two groups (4.5%). In the last assessment, the percentage of patients without evidence of disease, i.e., nonstimulated Tg < 1 ng/mL and no evidence of structural disease, was similar for the two preparations [92.3% in the rhTSH group and 97.7% in the THW group (p = 0.17)]. Conclusion Preparation with rhTSH was equally effective (short- and long-term) as THW for adjuvant RAI therapy of cN1b patients at intermediate risk and with apparently complete tumor resection.

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Section: Introductionsupporting

confidence: 63%

Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

Rosário

Mourão

Calsolari

2017

Arch. Endocrinol. Metab.

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“…For patients with PTC larger than 1 cm but smaller than 4 cm without extrathyroidal extension and without clinical evidence of lymph node metastases, the initial surgical procedure can be either a bilateral procedure (near‐total or total thyroidectomy) or a unilateral procedure (lobectomy). Near‐complete and complete thyroidectomy is often followed by radioactive iodine 131 (RAI) ablation therapy, which destroys the residual normal thyroid (remnant ablation) and can be used to evaluate the completeness of surgical resection with a post‐therapy whole‐body scan . Many patients then undergo serial neck ultrasound (US) examinations (imaging of the thyroid and lateral neck) with serum thyroglobulin (Tg) measurement to monitor for local recurrence.…”

mentioning

confidence: 99%

Papillary Thyroid Carcinoma Recurrence: Low Yield of Neck Ultrasound With an Undetectable Serum Thyroglobulin Level

McEachern

Khot

Padia

et al. 2018

J of Ultrasound Medicine

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“…These results make unlikely the long-term . The rate of recurrence was low (w3%) even in patients classified as intermediate (Cooper et al 2009, Perros et al 2014 or high risk (Lepoutre-Lussey et al 2014). This finding suggests that the importance of histological data as predictors of recurrence risk is minimized after complete tumor resection and when low Tg is achieved.…”

Section: Discussionmentioning

confidence: 69%

“…In contrast, adjuvant therapy with 131 I has been recommended when the histological data (tumor size, extrathyroid invasion, histologic subtype, vascular invasion, lymph node (LN) involvement) suggest a higher risk of recurrence (Cooper et al 2009, Rosario et al 2013, Lepoutre-Lussey et al 2014, Perros et al 2014. The need for radioiodine is controversial in the remaining patients.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with papillary thyroid carcinoma (PTC) submitted to total thyroidectomy with complete tumor resection, ablation of thyroid remnant with 131 I is not required in patients with microcarcinoma restricted to the thyroid with nonaggressive histology (Cooper et al 2009, Rosario et al 2013, Lepoutre-Lussey et al 2014, Perros et al 2014. In contrast, adjuvant therapy with 131 I has been recommended when the histological data (tumor size, extrathyroid invasion, histologic subtype, vascular invasion, lymph node (LN) involvement) suggest a higher risk of recurrence (Cooper et al 2009, Rosario et al 2013, Lepoutre-Lussey et al 2014, Perros et al 2014.…”

Section: Introductionmentioning

confidence: 99%

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Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

Mourão¹,

Rosário²,

Calsolari³

2015

Endocrine-Related Cancer

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This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) who had low nonstimulated thyroglobulin (Tg), measured with a second-generation assay, after total thyroidectomy and who were not submitted to ablation with 131 I. The objective was to define whether low postoperative nonstimulated Tg can be used as a criterion to spare patients with PTC from therapy with 131 I. This was a prospective study including 222 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroid invasion (pT4), aggressive histology, extensive lymph node (LN) involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg!0.3 ng/ml, negative antithyroglobulin antibodies (TgAb) and neck ultrasonography (US) showing no anomalies. Because of this finding, the patients were not submitted to ablation with 131 I. The time of follow-up ranged from 15 to 102 months (median 62 months). Of the 222 patients, 217 (97.7%) continued to have nonstimulated Tg !0.3 ng/ml and negative US. Tg was undetectable in the last assessment in 185 of these patients and detectable in 32. Five patients (2.2%) exhibited an increase in Tg, and LN metastases were detected in 4 (structural recurrence). One patient progressed to an increase in Tg, but disease was not detected by the imaging methods (biochemical recurrence). The results obtained here suggest that patients with PTC who have low nonstimulated Tg (measured with a second-generation assay and in the absence of TgAb) and negative neck US after thyroidectomy do not require ablation with 131 I.

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Postoperative radioactive iodine administration for differentiated thyroid cancer patients

Abstract: RAI is not administered in many low-risk patients who can be reliably followed up with serum thyroglobulin determination on L-thyroxine treatment and neck ultrasonography. RAI may be administered in case of abnormality, and this delay will not reduce the chance of cure.

Cited by 19 publications

References 54 publications

Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

Papillary Thyroid Carcinoma Recurrence: Low Yield of Neck Ultrasound With an Undetectable Serum Thyroglobulin Level

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

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