11. RADIOIODINE THERAPY
11.7. Radioiodine therapy for patients with negative diagnostic scans and
Elevated serum thyroglobulin (Tg) levels in patients with thyroid cancer after thyroidectomy and radioiodine ablation is a good indicator of presence of metastatic or recurrence of thyroid cancer tissue. The dilemma as to whether to treat such patients with therapeutic doses of 131I is always being questioned. There has been a trend toward using radioiodine therapy forthyroid cancer survivors who have elevated serum Tg levels, even in the absence of identifiable lesions [11.62-11.64]. Several small series have reported that lesions can often be seen on scans after therapy and that subsequent serum Tg levels areoften lower. Other investigators also find that this strategy occasionally helps localize occult disease. However, they recommend against widespread use of radioiodine therapy in all patients who have mild elevations of serum Tg in the absence of radiologicallyidentifiable disease [11.65, 11.66]. It is likely that patients seenat different stages of follow-up have been mixed in these studies,and more recent studies have shed light on this issue. Two-thirdsof patients who have detectable serum Tg after TSH stimulation and no other evidence of disease at one year after initial therapy will normalize their serum Tg at the subsequent control TSH stimulation, in the absence of any further treatment. This is the result of the disappearance of benign or malignant thyroid cells that have been irradiated and disappear slowly. In patients with persistent cancer, the serum Tg will gradually increase, and this trend will define a group needing additional treatment.However, in the absence of any alternative line of treatment it would be worthwhile to extend this experience to a larger group of patients.
11.8. Conclusion
Radioiodine has a major impact on the progressive control and cureof thyroid carcinoma.
There is agreement that 131I remnant ablationreduces local recurrence rates after total or near-total thyroidectomy, in those at higher risk for recurrence. It is very useful for iodine-avid disease that is not surgically accessible, especially diffuse lung metastases in younger individuals. Its efficacyin older individuals with large metastases is considerably lowerbut still poorly defined. More epidemiologic studies on the incidence and prevalence of complications of 131I are needed to enable us to better define the risks and benefits of this therapy. The growing knowledge of how 131I is incorporated intometastatic lesions, of the factors which can prolong its occupancy time, and of the development of lesion dosimetry methods will undoubtedly alter its usage pattern in the future. However, it has been acknowledged over the yearsthat radioiodine is not a panacea. It has significant side effects thatmust be considered in determining the risk-to-benefit ratiofor each patient.
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12. PRACTICAL ASPECTS OF RADIOIODINE THERAPY