What are the guidelines for use of radioiodine therapy to treat thyroid cancer?

Updated: May 09, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Radioiodine therapy is not recommended if all of the following are present [33] :

  • Classic papillary thyroid carcinoma
  • Primary tumor <1 cm
  • Intrathyroidal tumor
  • Unifocal or multifocal tumor
  • No detectable anti-Tg antibodies
  • Postoperative unstimulated Tg </ul>

    Radioiodine therapy is selectively recommended if any of the following is present when the combination of clinical factors predicts a significant risk of recurrence [33] :

    • 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 </ul>

      The ATA recommends radioiodine therapy for all patients if any of the following is present [1] :

      • Distant metastases
      • Extrathyroidal extension of the tumor regardless of tumor size
      • Primary tumor size >4 cm even in the absence of other higher-risk features.

      Radioiodine therapy is not recommended for patients with unifocal cancer under 1 cm without other higher-risk features or for patients with multifocal cancer when all foci are under 1 cm in the absence of other higher-risk features. [1]

      Radioiodine therapy is also recommended for selected patients with 1-4 cm thyroid cancers confined to the thyroid who have documented lymph node metastases or other higher-risk features, when the combination of age, tumor size, lymph node status, and individual histology predicts an intermediate to high risk of recurrence or death from thyroid cancer. [1]


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