Dr.Guttler’s Patient Thyroid BlogPost #18 Just Say No to Radioiodine for low risk Papillary thyroid cancer

Dr.Guttler’s Patient Thyroid BlogPost #18 Just Say No to Radioiodine for low risk Papillary thyroid cancer

Patient Thyroid BlogPost #18 Just Say No to Radioiodine for low risk Papillary thyroid cancer.

Dr.Guttler’s comments:

1. In patients with low-risk differentiated thyroid cancer undergoing thyroidectomy, the postoperative administration of radioiodine (iodine-131) is controversial in the absence of demonstrated benefits.

2.730 patients who could be evaluated after 3 years .

3.In patients with low-risk thyroid cancer undergoing thyroidectomy, a follow-up strategy that did not involve the use of radioiodine was not inferior to an ablation strategy with radioiodine.

4. Please get another opinion if your physicians want you to have radioiodine post surgery for low risk papillary thyroid cancer PTC.

5. Also if your PTC is < 1.6 cm please consider alternative therapy with Radiofrequency ablation RFA instead of surgery.The thyroid gland is left intact and there will be no need for thyroid hormone or a surgery scar. Selection for this is needed to determine if you are a candidate. Also follow up testing imaging and repeat biopsy is needed to determine if the cancer was ablated.

Cal me at 310-393-8860 or email to thyroid.manager@thyroid.com.

Ask for Alicia

Dr.G.

 

Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer

List of authors.

  • Sophie Leboulleux, Et Al
  • March 10, 2022
    N Engl J Med 2022; 386:923-932
    DOI: 10.1056/NEJMoa2111953

Abstract

In patients with low-risk differentiated thyroid cancer undergoing thyroidectomy, the postoperative administration of radioiodine (iodine-131) is controversial in the absence of demonstrated benefits.

Methods

In this prospective, randomized, phase 3 trial, we assigned patients with low-risk differentiated thyroid cancer who were undergoing thyroidectomy to receive ablation with postoperative administration of radioiodine (1.1 GBq) after injections of recombinant human thyrotropin (radioiodine group) or to receive no postoperative radioiodine (no-radioiodine group). The primary objective was to assess whether no radioiodine therapy was noninferior to radioiodine therapy with respect to the absence of a composite end point that included functional, structural, and biologic abnormalities at 3 years. Noninferiority was defined as a between-group difference of less than 5 percentage points in the percentage of patients who did not have events that included the presence of abnormal foci of radioiodine uptake on whole-body scanning that required subsequent treatment (in the radioiodine group only), abnormal findings on neck ultrasonography, or elevated levels of thyroglobulin or thyroglobulin antibodies. Secondary end points included prognostic factors for events and molecular characterization.

Results

Among 730 patients who could be evaluated 3 years after randomization, the percentage of patients without an event was 95.6% (95% confidence interval [CI], 93.0 to 97.5) in the no-radioiodine group and 95.9% (95% CI, 93.3 to 97.7) in the radioiodine group, a difference of −0.3 percentage points (two-sided 90% CI, −2.7 to 2.2), a result that met the noninferiority criteria. Events consisted of structural or functional abnormalities in 8 patients and biologic abnormalities in 23 patients with 25 events. Events were more frequent in patients with a postoperative serum thyroglobulin level of more than 1 ng per milliliter during thyroid hormone treatment. Molecular alterations were similar in patients with or without an event. No treatment-related adverse events were reported.

Conclusions

In patients with low-risk thyroid cancer undergoing thyroidectomy, a follow-up strategy that did not involve the use of radioiodine was noninferior to an ablation strategy with radioiodine regarding the occurrence of functional, structural, and biologic events at 3 years. (Funded by the French National Cancer Institute; ESTIMABL2 ClinicalTrials.gov number, NCT01837745. opens in new tab.)

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