Abstract
(1) Background—low-dose radioiodine ablation is an accepted strategy for the treatment of low- and intermediate-risk thyroid carcinomas, although there is no international consensus. The aim of this study is to describe the clinical experience with low-dose radioiodine ablation in patients with low- and intermediate-risk thyroid cancer compared to high-dose ablation. (2) Methods—174 patients with low- and intermediate-risk thyroid cancer, 90 treated with low-dose ablation and 84 treated with high-dose ablation, were included. The primary endpoint was response to treatment one year after ablation, defined by stimulated thyroglobulin, whole body scan and ultrasound imaging. (3) Results—an excellent response rate of 79.8% in the low-dose group and 85.7% in the high-dose group was observed (p = 0.049). Stimulated thyroglobulin at the moment of ablation (p = 0.032) and positive antithyroglobulin antibodies (p < 0.001) were independent predictive factors for nonexcellent response. Young age (p = 0.023), intermediate initial recurrence risk (p < 0.001) and low-dose ablation (p = 0.004) were independent predictive factors for recurrence. (4) Conclusion—low-dose ablation seemed to be less effective than high-dose ablation, especially in those patients with positive antithyroglobulin antibodies or higher stimulated thyroglobulin levels at the moment of ablation. Low dose was associated with higher recurrence rates, and lower age and intermediate initial recurrence risk were independent risk factors for recurrence in our sample.
Highlights
Differentiated thyroid cancer is the most frequent endocrine neoplasm, with a rising incidence in the last decades in Europe and the United States
There were some differences in the tumour histology, with a higher percentage of patients with Hürthle cell carcinoma in patients treated with high doses and a higher proportion of mixed tumours in the low-dose group
Regarding the risk of recurrence, we found that a higher age was a protective factor, and that this differs from the data reported for example by Verburg et al [25], who found a higher specific mortality for thyroid cancer and recurrence rate in patients > 45 years treated with low-dose compared to those treated with high-dose ablation
Summary
Differentiated thyroid cancer is the most frequent endocrine neoplasm, with a rising incidence in the last decades in Europe and the United States. This increasing incidence is mainly attributed to the increased diagnosis of clinically nonrelevant papillary microcarcinomas [1,2]. Classic thyroid cancer management includes surgery followed by radioiodine ablation. In its last edition, the American Thyroid Association (ATA) guidelines for the management of thyroid cancer included the recommendation for an individualized treatment regarding surgery, and radioiodine (RAI) ablation. After surgery and depending on the initial recurrence risk, the patient could undergo a RAI ablation with a low or high dose [5,6]
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