Radioiodine lobar ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer

Abstract

This study seeks to evaluate the role of radioiodine in the ablation of the remaining thyroid lobe, following a histopathological diagnosis of minimally invasive follicular carcinoma or papillary carcinoma of > or =1.5 cm size in patients undergoing hemithyroidectomy. There were 93 patients (69 females and 24 males) with an average age of 37.3+/-12.5 years (range, 16-70 years) and a mean follow-up duration of 46 months. Sixty-six of the patients had papillary cancer and remaining 27 had follicular thyroid cancer. The mean 24 h radioiodine neck uptake at the first visit was 17.2+/-7.3% (4.4-34%). In view of the large amount of thyroid tissue to be ablated, which may produce radiation induced thyroiditis, low doses of radioiodine (15-60 mCi) were administered to the patients. The patients were evaluated 6 months after radioiodine therapy with a 131I whole-body scan and 48 h radioiodine neck uptake, and a thyroglobulin assay after 4-6 weeks of levothyroxine withdrawal. The thyroid lobe was completely ablated in 53 patients (56.9%) after one dose of I and the remaining patients had partial thyroid ablation, with the mean radioiodine neck uptake being reduced to 3.1+/-2.4%. The mean first dose of 131I was 31.8+/-11.7 mCi; the estimated mean absorbed dose was 251.3+/-149.3 Gy (range, 120-790 Gy). Around 30% patients, in each of whom a remnant thyroid lobe was ablated with a single dose of radioiodine, received < or =200 Gy. The cumulative ablation rate was 92.1% after two doses of 131I. Only seven patients needed a third dose of 131I. In our cohort, 15 patients (16.1%) complained of throat discomfort and neck pain. All of them were managed with mild analgesics except three patients who needed additional oral prednisolone for 7-10 days to overcome neck oedema. We conclude that, although completion thyroidectomy remains the standard treatment after hemithyroidectomy in cases of differentiated thyroid cancer, radioiodine ablation of an intact thyroid lobe is possible and it can be achieved with much smaller doses of radioiodine than previously believed. Lobar ablation is an attractive alternative to surgery for those who refuse to undergo completion thyroidectomy or had complications during initial surgery. However, the long-term outcome in this subset of patients remains to be determined.

Comparison of Completion Thyroidectomy and Primary Total Surgery for Differentiated Thyroid Cancer: A Meta-Analysis

“…However, it is feared that multiple doses of 131 I to ablate large thyroid remnants may produce radiation thyroiditis, odynophagia, cervical edema, etc. Thus, the adverse reactions limited this approach [23].…”

Complications of Completion Versus Total Thyroidectomy

“…131 I ablation of the remaining thyroid remnant is a treatment choice for achieving a completion thyroidectomy. However, the disadvantages such as multiple doses of 131 I for a successfull ablation, large thyroid remnants, pulmonary fibrosis, leukemia and temporary bone marrow suppressions limit this approach (Bal et al, 2003).…”

Tratamento do microcarcinoma de tireóide

“…Contrário a isto, em pacientes tratados com lobectomia, um estudo mostrou que a dose de 30mCi de iodo 131 promoveu ablação em 80% e apenas 18% apresentaram tireoidite (44), e outro alcançou 57% de eficácia com doses variando de 15 a 60mCi e somente 16% dos pacientes tiveram reações locais após o radioiodo (45). Estes estudos até propõem a radioiodoterapia como alternativa à complementação cirúrgica.…”