Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Endocrine
Published in: Endocrine 1/2020

01-04-2020 | Metastasis | Original Article

Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer

Authors: Domenico Albano, Mattia Bonacina, Rexhep Durmo, Francesco Bertagna, Raffaele Giubbini

Published in: Endocrine | Issue 1/2020

Login to get access

Abstract

Purpose

The aim of our study was to compare the efficacy of thyroid remnant ablation using low (1.1 GBq) and intermediate-high radioiodine (RAI) activity (1.85–3.7 GBq) in low-risk differentiated thyroid carcinoma (DTC) and to evaluate the staging role of the whole body scan (WBS) in detection extrathyroidal disease.

Materials and methods

We retrospectively included 277 patients who underwent total thyroidectomy and RAI for low-risk DTC and divided them in two groups according to RAI activity at ablation: group 1 (n = 174) treated with low activity (1.1 GBq), and group 2 (n = 103) with intermediate-high activity (1.85–3.7 GBq). To evaluate the successful ablation rate, the WBS 1 year after RAI was visually interpreted using a three-point scale: score 0 in case of absence of visible RAI uptake in thyroid bed; score 1 in presence of faint uptake in the thyroid bed; and score 2 in case of significant RAI uptake in thyroid bed.

Results

The success ablation rate was significantly higher in group 2 than group 1 (p < 0.001) with the presence of a positive WBS (score 1–2) in 65% low-activity group and 33% in intermediate-high group. Considering response to therapy categories, excellent response rate was significantly higher in group 2 (p = 0.020), while indeterminate response was higher in group 1 (p value = 0.005). Post RAI imaging revealed extrathyroidal uptake in 27 cases: 17 laterocervical nodal and 10 distant metastases. In both groups similar detection rate of nodal and distant metastases were recognized without any statistical difference.

Conclusions

The ablation rate with intermediate-high RAI activity (1.85–3.7 GBq) was better than with a low activity (1.1 GBq). First WBS may help to recognize nodal and distant metastases in about 10% of cases changing clinical stage and subsequent management.
Literature
1.
2.
B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov et al. American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016(26), 1–133 (2015)
3.
C.S. Bal, A.K. Padhy, Radioiodine remnant abaltion: a critical review. World J. Nucl. Med. 14, 144–155 (2015)CrossRef
4.
L.H. Duntas, D.S. Cooper, Review on the occasion of a decade of recombinant human TSH: prospects and novel uses. Thyroid 18, 509–516 (2008)CrossRef
5.
C. Bal, A.K. Padhy, S. Jana, G.S. Pant, A.K. Basu, Prospective randomized clinical trial to evaluate the optimal dose of 131I for remnant ablation in patients with differentiated thyroid carcinoma. Cancer 77, 2574–2580 (1996)CrossRef
6.
K. Watanabe, M. Uchiyama, K. Fukuda, The outcome of I-131 ablation therapy for intermediate and high-risk differentiatetd thyroid cancer using a strict definition of successful ablation. Jpn. J. Radio. 35, 505–510 (2017)CrossRef
7.
I.D. Hay, G.B. Thompson, C.S. Grant et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J. Surg. 26, 879–885. (2002)CrossRef
8.
J. Jonklaas, D.S. Cooper, K.B. Ain et al. Radioiodine therapy in patients with stage I differentiated thyroid cancer. Thyroid 20, 1423–1424 (2010)CrossRef
9.
E. Hindie, D. Taieb, A.M. Avram et al. Radioactive iodine ablation in low-risk thyroid cancer. Lancet Diabetes Endocrinol. 6, 686 (2018)CrossRef
10.
A.S. Moten, H. Zhao, A.I. Willis, The overuse of radioactive iodine in low-risk papillary thyroid cancer patients. Surg. Oncol. 29, 184–189 (2019)CrossRef
11.
A.M. Sawka, K. Thephamongkhol, M. Brouwers, L. Thabane, G. Browman, H.C. Gerstein, Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 89, 3668–3676 (2004)CrossRef
12.
A. Hackshaw, C. Harmer, U. Mallick, M. Haq, J.A. Franklyn, 131I activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J. Clin. Endocrinol. Metab. 92, 28–38 (2007)CrossRef
13.
M. Schlumberger, B. Catargi, I. Borget, D. Deandreis, S. Zerdoud, B. Bridji et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N. Engl. J. Med. 366, 1663–1673 (2012)CrossRef
14.
U. Mallick, C. Harmer, B. Yap, J. Wadsley, S. Clarke, L. Moss et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N. Engl. J. Med. 366, 1674–1685 (2012)CrossRef
15.
M. Tuttle, L.F. Morris, B. Haugen, J. Shah, J.A. Sosa, E. Rohren, R.M. Subramaniam, J.L. Hunt, N.D. Perrier, Thyroid‐differentiated and anaplastic carcinoma (Chapter 73). In: AJCC Cancer Staging Manual, 8th edn. ed. by M.B. Amin, S.B. Edge, F. Greene, D. Byrd, R.K. Brookland, M.K. Washington, J.E. Gershenwald, C.C. Compton, K.R. Hess, D.C. Sullivan, J.M. Jessup, J. Brierley, L.E. Gaspar, R.L. Schilsky, C.M. Balch, D.P. Winchester, E.A. Asare, M. Madera, D.M. Gress, L.R. Meyer (Springer International Publishing, New York City, 2017)
16.
D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–214 (2009)CrossRef
17.
V. Zilioli, A. Peli, M.B. Panarotto, G. Magri, A. Alkraisheh, C. Wiefels et al. Differentiated thyroid carcinoma: incremental diagnosi value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine 56, 551–559 (2017)CrossRef
18.
S.C. Clement, R.P. Peeters, C.M. Ronckers, T.P. Links, M.M. van den Heuvel-Eibrink, E.J. Nieveen van Dijkum et al. Intermediate and longterm adverse effects of radioiodine therapy for differentiated thyroid carcinoma—a systematic review. Cancer Treat. Rev. 41, 925–934 (2015)CrossRef
19.
L. Agate, F. Bianchi, F. Brozzi, P. Santini, E. Molinaro, V. Bottici et al. Less than 2% of the low and intermediate risk differentiatetd thyroid cancers show distant metastases at post-ablation whole-body scan. Eur. Thyroid J. 8, 90–95 (2019)CrossRef
20.
D. Albano, M.B. Panarotto, R. Durmo, C. Rodella, F. Bertagna, R. Giubbini, Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer. Endocrine 63, 79–86 (2019)CrossRef
21.
C. Durante, N. Haddy, E. Baudin, S. Leboulleux, D. Hartl, J.P. Travagli et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J. Clin. Endocrinol. Metab. 91, 2892–2899 (2006)CrossRef
22.
A. Campenni, L. Giovanella, S.A. Pignata, A. Vento, A. Alibrandi, L. Sturiale et al. Undetectable or low (<1 ng/ml) postsurgical thyroglobulin values do not rule out metastases in early stage differentiated thyroid cancer patients. Oncotarget 9, 17491–17500 (2018)CrossRef
23.
E. Hindie, D. Melliere, F. Lange, I. Hallaj, C. de Labriolle-Vaylet, C. Jeanguillaume et al. Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis? Eur. J. Nucl. Med. Mol. Imaging 30, 974–981 (2003)CrossRef
24.
E. Hindie, P. Zanotti-Fregonara, I. Keller, F. Duron, J.Y. Devaux, M. Calzada-Nocaudie et al. Bone metastases of differentiated thyroid cancer: impact of early 131I-based detection on outcome. Endocr. Relat. Cancer 14, 799–807 (2007)CrossRef
25.
D. Casara, D. Rubello, G. Saladini, G. Masarotto, A. Favero, M.E. Girelli et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J. Nucl. Med. 34, 1626–1631 (1993)PubMed
26.
Y. Orita, I. Sugitani, M. Matsuura, M. Ushijima, K. Tsukahara, Fujimoto et al. Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma. Surgery 147, 424–431 (2010)CrossRef
27.
D. Albano, F. Bertagna, M. Bonacina, R. Durmo, E. Ceruddelli, M. Gazzilli et al. Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines. Eur. J. Endocrinol. 179, 143–151 (2018)CrossRef
28.
A. Hackshaw, C. Harmer, U. Mallick, M. Haq, J.A. Franklyn, 131Iactivity for remnant ablation in patients with differentiated thyroidcancer: a systematic review. J. Clin. Endocrinol. Metab. 92, 28–38 (2007)CrossRef
29.
D. Peizhun, X. Jiao, Y. Zhou, Y. Li, S. Kang, D. Zhang et al. Low versus high radioiodine activity to ablate the thyroidafterthyroidectomy for cancer: a meta-analysis of randomizedcontrolled trials. Endocrine 48, 96–105 (2015)CrossRef
30.
R. Ciappuccini, J. Hardouin, N. Heutte, D. Vaur, E. Quak, J.P. Rame et al. Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden. Eur. J. Endocrinol. 171, 247–252 (2014)CrossRef
31.
H.J. Park, J.J. Min, H.S. Bom, J. Kim, H.C. Song, S.Y. Kwon, Early stimulated thyroglobulin for response prediction after recombinant human thyrotropin-aided radioiodine therapy. Ann. Nucl. Med. 31, 616–622 (2017)CrossRef
32.
U. Mousa, A.S. Yikilmaz, A. Nar, Stimulated thyroglobulin values above 5.6 ng/ml before radioactive iodine ablation treatment following levothyroxine withdrawal is associated with a 2.38-fold risk of relapse in Tg-ab negative subjects with differentiated thyroid cancer. Clin. Transl. Oncol. 19, 1028–1034 (2017)CrossRef
33.
A. Piccardo, F. Arecco, M. Puntoni, L. Foppiani, M. Cabria, S. Corvisieri et al. Focus on high-risk DTC patients: high postoperative serum thyroglobulin level is a strong predictor of disease persistence and is associated to progression-free survival and overall survival. Clin. Nucl. Med. 38, 18–24 (2013)CrossRef
Metadata
Title
Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer
Authors
Domenico Albano
Mattia Bonacina
Rexhep Durmo
Francesco Bertagna
Raffaele Giubbini
Publication date
01-04-2020
Publisher
Springer US
Published in
Endocrine / Issue 1/2020
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-019-02148-9

Other articles of this Issue 1/2020

Endocrine 1/2020 Go to the issue

Endocrine Genetics/Epigenetics

Structural insights revealed by two novel THRB mutations

Original Article

Identification of common key genes and pathways between type 1 diabetes and multiple sclerosis using transcriptome and interactome analysis

Correction

Correction to: Exploring the molecular insights of concurrent composite mucoepidermoid carcinoma and papillary thyroid carcinoma

Original Article

Thirteen novel CLCNKB variants and genotype/phenotype association study in 42 Chinese patients with Bartter syndrome type 3

Original Article

Sarcopenia is a prognostic factor for TKIs in metastatic thyroid carcinomas

Endocrine Genetics/Epigenetics

Epigenetic mechanism in search for the pathomechanism of diabetic neuropathy development in diabetes mellitus type 1 (T1DM)
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits