What are the NCCN guidelines on radioiodine therapy in the treatment of thyroid cancer?

Updated: Jun 24, 2020
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Answer

NCCN guidelines recommend radioiodine (131I) therapy if any of the following are present [5] :

  • Extrathyroidal extension
  • Tumor >4 cm in diameter
  • Postoperative unstimulated thyroglobulin (Tg) level >5-10 ng/mL

Radioiodine therapy is not recommended if all of the following are present [5] :

  • Classic papillary thyroid carcinoma (PTC)
  • Primary tumor < 1 cm
  • Intrathyroidal tumor
  • Unifocal or multifocal tumor
  • No detectable anti-Tg antibodies
  • Postoperative unstimulated Tg < 1 ng/mL

Radioiodine therapy is selectively recommended if any of the following are present when the combination of clinical factors predicts a significant risk of recurrence: [5]

  • Primary tumor 1-4 cm
  • High-risk histology
  • Lymphovascular invasion
  • Cervical lymph node metastases
  • Macroscopic multifocality (one focus >1 cm)
  • Presence of anti-Tg antibodies
  • Postoperative unstimulated Tg < 5-10 ng/mL

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