Abstract
Radioiodine therapy (RAI) is usually a standard procedure performed after thyroidectomy in differentiated thyroid cancer (DTC). While the indication for RAI in high-risk patients has been established in various national and international guidelines, there is an ongoing discussion with regard to intermediate-risk patients. In addition to the inconsistent definition of this risk category, the absence of large multinational prospective randomized controlled trials forms the basis of the debate. In this context, the actual pattern of care and national guidelines in the country where the patient is living plays an important role with respect to regional iodine supply and goiter prevalence, preoperative diagnostics (fine needle aspiration biopsy), and corresponding surgical strategies. Participatory decision-making between physician and informed patient, which is demanded in principle today anyway, is of particular importance in this situation. This article will discuss the approach of shared decision making for radioiodine therapy in intermediate-risk DTC.
Highlights
After thyroidectomy, radioiodine therapy (RAI) is the standard treatment for most patients with differentiated papillary or follicular thyroid cancer (DTC)
It is crucial to consider the divergent definition of intermediate-risk patients, as various national and international guidelines and societies including the European Thyroid Association (ETA) and the American Thyroid Association (ATA) use non-uniform risk classifications, whereby a difference must be considered between the risk of DTC related death and the risk of recurrence
In the British guideline, published in 2014, RAI [8] is recommended for patients in the definite indication category pT3/4 and M1, personalized decision making is recommended in T1b/2 and N1 with regard to factors as resected metastatic
Summary
Radioiodine therapy (RAI) is the standard treatment for most patients with differentiated papillary or follicular thyroid cancer (DTC). Experts from different disciplines in various countries have divergent views on the indication of RAI in patients who are not classified as high-risk, whereby these classifications differ. The pattern of care standards in different countries are not necessarily the same, which is why approaches cannot be directly applied without restriction. The issue becomes even more complex by the lack of randomized prospective trials with evidence that provides a basis for recommendations. The absence of such evidence makes participatory decision making between physician and patient important in this situation
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