Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

Abstract

SummaryThe procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for 131I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative 131I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC ≤1 cm 131I ablation may be helpful in an individual constellation. Preparation for 131I ablation requires low iodine diet for two weeks and TSHstimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSHstimulation (necessary for 131I-therapy in patients with metastases, higher sensitivity of 131I whole-body scan) are discussed. In most centers standard activities are used for 131I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of 131I should not exceed 1–10 MBq, alternative tracers are 123I or 124I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene.

Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective

“…To achieve an adequate TSH level after surgery, patients forgo thyroid hormone replacement for 3-6 weeks prior to ablation. In Germany, this typically commences immediately after thyroidectomy (2). However, in countries where access to radio-protective wards is more limited, patients may commence thyroid hormone therapy after thyroidectomy, only to withdraw at a later date in preparation for their ablation therapy.…”

Hypothyroidism and Radioiodine Therapy

“…Ablation also allows sensitive "post-therapy" whole-body scintigraphy (rxWBS) (Fig. 7) that may detect previously occult metastases (Dietlein et al, 2007) and serves to treat any microscopic tumour deposits.…”

“…Ablation, therefore, may reduce long-term morbidity and possibly, mortality (Dietlein et al, 2007, Sawka et al, 2004, Pacini et al, 2005. Ablation success is evaluated 6-12 months after the ablation procedure.…”

Preparing Patients for Radioiodine Treatment: Increasing Thyroid Cell Uptake and Accelerating the Excretion of Unbound Radioiodine

“…It is a regular segment of the standard therapeutic procedure in differentiated thyroid carcinoma treatment and it comes recommended by a number of authorities in the field Dietlein et al, 2007;Luster et al, 2008;National Comprehensive Cancer Network [NCCN], 2010;). Certain differences in opinion on the subject are concerned only with the dose that is applied, as well as with whether radioactive iodine therapy should be utilized in lower risk patients (ȃ а ая&Ша , 1981;Haq et al, 2004;Ringel&Ladenson, 2004;Cooper et al, 2006;Pacini et al, 2006;Gheriani, 2006).…”