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Assessing potential impact of 2015 American Thyroid Association guidelines on community standard practice for I-131 treatment of low-risk differentiated thyroid cancer: case study of Jordan

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Abstract

Objectives

The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 131I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the 131I activity utilized by an academic tertiary hospital in Jordan.

Methods

All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and 131I activity was assigned accordingly. The actual 131I activity administered was compared with that recommended by the 2015 ATA guidelines.

Results

In total, 135/182 DTC patients (74.2%) managed at JUH underwent 131I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial 131I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding 131I therapy altogether in the 2015 ATA low-risk patients would result in decreasing the 131I activity in the overall patient population by 37%. Withholding 131I therapy only in low-risk papillary thyroid microcarcinomas while administering 1.11 GBq of 131I to other low-risk patients would result in 28% reduction of 131I.

Conclusion

This study demonstrates a significant reduction in 131I therapeutic activity that would be given to DTC patients in an academic tertiary setting in Jordan, following acceptance of the 2015 ATA recommendations. Institutions that adopted the 2015 ATA guidance should measure outcomes in comparison to their historical controls and report those findings, while long-term results of randomized controlled trials are forthcoming.

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Acknowledgements

The data was presented in part by N.J.R. at the 2020 Annual Meeting of the American College of Nuclear Medicine, receiving Professor Ralph Blumhardt Award for the best research abstract from the developing countries.

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Authors and Affiliations

  1. Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan

    Malik E. Juweid, Nidal J. Rabadi, Mohammed Aloqaily, Ahmad Al-Momani, Gassem Abu Ain, Amr Abulaban, Ibrahim Taha & Abdullah Alhouri

  2. Department of Radiology, Penn State Health, Hershey, PA, USA

    Mark Tulchinsky

  3. Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan

    Majd Arabiat, Hussam Al Hawari, Munther Al-Momani & Ayman Zayed

  4. Department of Special Surgery, University of Jordan, Amman, Jordan

    Ayman Mismar & Nader Albsoul

  5. Department of Histopathology, Microbiology and Forensic Medicine, University of Jordan, Amman, Jordan

    Mousa A. Al-Abbadi

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  1. Malik E. Juweid
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  2. Nidal J. Rabadi
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  3. Mark Tulchinsky
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  4. Mohammed Aloqaily
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  16. Mousa A. Al-Abbadi
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Contributions

M.T. and M.E.J.: developed the study concept, lead the manuscript writing, in-part performed the data analysis, and reviewed the nuclear medicine images. N.J.R.: coordinated distributed clinical information retrieval by the team of abstractors from the recorded hospital information, managed cross-validation of data entries, prepared initial tabulation of the results, and coordinated manuscript editing. N.A., A.M., A.A., M.A., A.Al-M., M.A., G.A.A., A.A., I.T., and A.Z.: manual patient retrieval from the medical records, extraction of clinical and laboratory data information, database data input, data cross-validation, and participation in manuscript editing. H.Al-H. and M.Al-M.: responsible for validation of the risk assignment according to the 2015 ATA guidelines, and participation in manuscript editing. M.A.Al-A.: review of histopathology, additional pathology description to fulfill 2015 ATA data requirements, and manuscript editing.

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Correspondence to Mark Tulchinsky.

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Juweid, M.E., Rabadi, N.J., Tulchinsky, M. et al. Assessing potential impact of 2015 American Thyroid Association guidelines on community standard practice for I-131 treatment of low-risk differentiated thyroid cancer: case study of Jordan. Endocrine 73, 633–640 (2021). https://doi.org/10.1007/s12020-021-02698-x

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