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Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review.
Endocr Relat Cancer 2014; 21(6):R473-84ER

Abstract

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the post-operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.

Authors+Show Affiliations

University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA ely.wolin@us.af.mil lewolin@hotmail.com.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25277792

Citation

Blumhardt, Ralph, et al. "Current Controversies in the Initial Post-surgical Radioactive Iodine Therapy for Thyroid Cancer: a Narrative Review." Endocrine-related Cancer, vol. 21, no. 6, 2014, pp. R473-84.
Blumhardt R, Wolin EA, Phillips WT, et al. Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review. Endocr Relat Cancer. 2014;21(6):R473-84.
Blumhardt, R., Wolin, E. A., Phillips, W. T., Salman, U. A., Walker, R. C., Stack, B. C., & Metter, D. (2014). Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review. Endocrine-related Cancer, 21(6), pp. R473-84. doi:10.1530/ERC-14-0286.
Blumhardt R, et al. Current Controversies in the Initial Post-surgical Radioactive Iodine Therapy for Thyroid Cancer: a Narrative Review. Endocr Relat Cancer. 2014;21(6):R473-84. PubMed PMID: 25277792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review. AU - Blumhardt,Ralph, AU - Wolin,Ely A, AU - Phillips,William T, AU - Salman,Umber A, AU - Walker,Ronald C, AU - Stack,Brendan C,Jr AU - Metter,Darlene, Y1 - 2014/10/02/ PY - 2014/10/4/entrez PY - 2014/10/4/pubmed PY - 2015/6/17/medline KW - 131I KW - radioactive iodine therapy KW - thyroid cancer KW - thyroid cancer resistance KW - thyroid cancer staging SP - R473 EP - 84 JF - Endocrine-related cancer JO - Endocr. Relat. Cancer VL - 21 IS - 6 N2 - Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the post-operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented. SN - 1479-6821 UR - https://www.unboundmedicine.com/medline/citation/25277792/Current_controversies_in_the_initial_post_surgical_radioactive_iodine_therapy_for_thyroid_cancer:_a_narrative_review_ L2 - https://erc.bioscientifica.com/doi/10.1530/ERC-14-0286 DB - PRIME DP - Unbound Medicine ER -