Abstract
Radioactive iodine (RAI; I-131) has been used to destroy thyroid carcinoma tissue postoperatively in patients with and without known residual disease since the mid-twentieth century. By eliminating remaining normal thyroid tissue, RAI ablation facilitates monitoring for persistent or recurrent thyroid carcinoma with thyroglobulin levels and iodine scans. Furthermore, for those patients with invasive cancers, extensive locoregional or distant metastases, many studies demonstrate that RAI treatment improves cause-specific and disease-free survival, but there are many challenges in the thyroid cancer literature to evaluating the benefits of RAI remnant ablation. There is a lack of prospective randomized controlled trials to identify effectiveness of RAI. Moreover, the use of as many as 16 staging systems, pooling of histological subtypes that respond differently to iodine, and lack of agreement of definitions for “low risk” versus “high risk” make it difficult to compare the outcomes for different stages/risks from across studies. In addition, the majority of analyses do not account for ethnic and geographic differences in total incidence and incidence of different histological types of differentiated thyroid cancer (DTC). Furthermore, since recurrence and death from thyroid cancer can be seen many years after the initial diagnosis, attaining significant outcome data depends upon the duration of a study which is, oftentimes, too short to provide meaningful data. Lastly, recent studies use newer methods for detecting recurrence of disease such as with more sensitive thyroglobulin assays and high-resolution ultrasound, making it difficult to compare outcomes from older studies where less sensitive whole-body scanning was performed.
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Sacks, W., Waxman, A.D. (2012). Radioactive Iodine Therapy. In: Braunstein, G. (eds) Thyroid Cancer. Endocrine Updates, vol 32. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0875-8_13
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