Radioiodine Remnant Ablation: A Critical Review

  • Chandra Sekhar Bal
  • Ajit Kumar Padhy
Part of the Medical Radiology book series (MEDRAD)


Radioiodine remnant ablation is considered a safe and effective method for eliminating residual thyroid tissue, as well as microscopic disease, if at all present in thyroid bed following thyroidectomy. The rationale of radioiodine remnant ablation (RRA) is that in the absence of thyroid tissue, serum thyroglobulin measurement can be used as an excellent tumor marker. Serum Tg measurement is the most sensitive under TSH stimulation for the detection of persistent or recurrent disease. Other considerations are like the presence of significant remnant thyroid tissue makes detection and treatment of nodal or distant metastases difficult. Rarely, microscopic disease in thyroid bed if not ablated, in future, could be a source of anaplastic transformation. On the other hand, microscopic tumor emboli in distant sites could be the cause of distant metastasis too. The ablation of remnant tissue would in all probability eliminate these theoretical risks. It may be noted that all these are unproven contentious issues except post-ablation serum Tg estimation that could be a good tumor marker for detecting early biochemical recurrence in long-term follow-up strategy. Radioactive iodine is administered as a form of ‘adjuvant therapy’ for remnant ablation. There have been several reports with regard to the administered dose for remnant ablation. The first report of a prospective randomized clinical trial was published from India by a prospective randomized study conducted at the All India Institute of Medical Sciences, New Delhi in the year 1996. The study reported that increasing the empirical 131I initial dose to more than 50 mCi results in plateauing of the dose-response curve and thus, conventional high dose remnant ablation needs critical evaluation. Recently two more important studies were published at the time of writing this review: one was by a French group and the other was a HiLo trial from UK on a similar line. Interestingly all three studies conducted in three different geographical regions of the world showed exactly the same conclusion. The new era of low-dose remnant ablation has taken a firm scientific footing across the continents. The recent meta-analysis based on all randomized control trials on RRA (a class 1 category of evidence) published by Cheng et al has summarized the findings of several studies conducted during the past 15 years and concluded that 30 mCi of 131I is sufficient enough for ablation. This chapter critically analyzes the evolution of radioiodine remnant ablation over the years from very high dose empirical to a more logical and evidence-based low dose therapy.


Thyroid Cancer Differentiate Thyroid Cancer Whole Body Scan Urinary Iodine Concentration Remnant Ablation 
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  1. Bal C, Padhy AK, Jana S, Pant GS, Basu AK (1996) Prospective randomized clinical trial to evaluate the optimal dose of 131I for remnant ablation in patients with differentiated thyroid carcinoma. Cancer 77:2574–2580PubMedCrossRefGoogle Scholar
  2. Bal CS, Kumar A, Pant GS (2004) Radioiodine dose for remnant ablation in differentiated thyroid carcinoma: a randomized clinical trial in 509 patients. J Clin Endocrinol Metab 89:1666–1673PubMedCrossRefGoogle Scholar
  3. Bal CS, Kumar A, Chandra P, Dwivedi SN, Pant GS (2006) A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing sub-total thyroidectomy. Acta Oncol 45:1067–1072PubMedCrossRefGoogle Scholar
  4. Bal CS, Chandra P, Kumar A, Dwivedi SN (2010) A randomized non-inferiority trial to determine the optimum dose of radioiodine for remnant ablation in differentiated thyroid cancer [abstract]. Endocr Rev 31(Suppl 1):S1674Google Scholar
  5. Bal C, Chandra P, Kumar A, Dwivedi S (2012) A randomized equivalence trial to determine the optimum dose of iodine-131 for remnant ablation in differentiated thyroid cancer. Nucl Med Commun 33:1039–1047PubMedCrossRefGoogle Scholar
  6. Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, Cailleux AF, Lumbroso JD, Parmentier C, Schlumberger M (1998) Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83:553–559PubMedCrossRefGoogle Scholar
  7. Belerwaltes WH, Rabbani R, Dmuchowski C, Lloyd RV, Eyre P, Mallette S (1984) An analysis of “Ablation of Thyroid Remnants” with 1–131 in 511 patients from 1947–1984: experience at University of Michigan. J Nucl Med 25:1287–1293Google Scholar
  8. Berg G, Lindstedt G, Suurku¨ la M, Jansson S (2002) Radioiodine ablation and therapy in differentiated thyroid cancer under stimulation with recombinant human thyroid-stimulating hormone. J Endocrinol Invest 25:44–52Google Scholar
  9. Brabant G (2008) Thyrotropin suppressive therapy in thyroid carcinoma: what are the targets? J Clin Endocrinol Metab 93:1167–1169PubMedCrossRefGoogle Scholar
  10. Byar DP, Green SB, Dor P, Williams ED, Colon J, van Gilse HA, Mayer M, Sylvester RJ, van Glabbeke M (1979) A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group. Eur J Cancer 15:1033–1041PubMedCrossRefGoogle Scholar
  11. Chen AY, Jemal A, Ward EM (2009) Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer 115:3801–3807PubMedCrossRefGoogle Scholar
  12. Cheng W, Ma C, Fu H, Li J, Chen S, Wu S, Wang H (2013) Low- or high-dose radioiodine remnant ablation for differentiated thyroid carcinoma: a meta-analysis. J Clin Endocrinol Metab 98:1353–1360PubMedCrossRefGoogle Scholar
  13. Chow SM, Law SC, Mendenhall WM, Au SK, Chan PT, Leung TW, Tong CC, Wong IS, Lau WH (2002) Papillary thyroid carcinoma: prognostic factors and the role of radioiodine and external radiotherapy. Int J Radiat Oncol Biol Phys 52:784–795Google Scholar
  14. Chow SM, Yau S, Kwan CK, Poon PC, Law SC (2006) Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC, 6th edition. EndocrRelat Cancer 13:1159–1172CrossRefGoogle Scholar
  15. Cooper DS, Specker B, Ho M, Sperling M, Ladenson PW, Ross DS, Ain KB, Bigos ST, Brierley JD, Haugen BR, Klein I, Robbins J, Sherman SI, Taylor T, Maxon HR (1998) Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid 8:737–744PubMedCrossRefGoogle Scholar
  16. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 19:1167–1214PubMedCrossRefGoogle Scholar
  17. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167PubMedCrossRefGoogle Scholar
  18. DeGroot LJ, Kaplan EL, McCormick M, Straus FH (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–424PubMedCrossRefGoogle Scholar
  19. Duntas LH, Cooper DS (2008) Review on the occasion of a decade of recombinant human TSH: prospects and novel uses. Thyroid 18:509–516PubMedCrossRefGoogle Scholar
  20. Durante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, Costante G, Meringolo D, Bruno R, Trulli F, Massa M, Maniglia A, D’Apollo R, Giacomelli L, Ronga G, Filetti S; PTC Study Group (2013) Papillary thyroid cancer: time course of recurrences during post-surgery surveillance. J Clin Endocrinol Metab 98:636–642Google Scholar
  21. Edmonds CJ, Hayes S, Kermode JC, Thompson BD (1977) Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine. Br J Radiol 50:799–807PubMedCrossRefGoogle Scholar
  22. Filetti S, Tuttle RM, Sherman SI (2013) Medical management of differentiated Epithelial Cell Thyroid Cancer. In Braverman LE, Cooper DS (eds) Werner & Ingebar’s Thyroid: a fundamental and clinical text, 10th edn. Lippincort William & Wilkins, Philadelphia, pp 725–743Google Scholar
  23. Goldman JM, Line BR, Aamodt RL, Robins J (1980) Influence of triiodothyronine withdrawal time on 131-I uptake post-thyroidectomy for thyroid cancer. J Clin Endocrinol Metab 50:734–739PubMedCrossRefGoogle Scholar
  24. Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA (2007) 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. J Clin Endocrinol Metab 92:28–38Google Scholar
  25. Han JM, Kim WB, Yim JH, Kim WG, Kim TY, Ryu JS, Gong G, Sung TY, Yoon JH, Hong SJ, Kim EY, Shong YK (2012) Long-term clinical outcome of differentiated thyroid cancer patients with undetectable stimulated thyroglobulin level one year after initial treatment. Thyroid 22:784–790PubMedCentralPubMedCrossRefGoogle Scholar
  26. Handkiewicz-Junak D, Wloch J, Roskosz J, Krajewska J, Kropinska A, Pomorski L, Kukulska A, Prokurat A, WygodaZ, Jarzab B (2007) Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 48:879–888Google Scholar
  27. Hänscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, Ladenson PW, Wahl RL, Schlumberger M, Ricard M, Driedger A, Kloos RT, Sherman SI, Haugen BR, Carriere V, Corone C, Reiners C (2006) Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 47:648–654PubMedGoogle Scholar
  28. Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI, Cooper DS, Graham KE, Braverman LE, Skarulis MC, Davies TF, DeGroot LJ, Mazzaferri EL, Daniels GH, Ross D, Luster M, Samuels M, Becker DV, Maxon III HR, Cavalieri RR, Spencer CA, McEllin K, Weintraub B, Ridgway C (1999) A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 84:3877–3885Google Scholar
  29. Hay ID (2007) Management of patients with low-risk papillary thyroid carcinoma. Endocr Prac 13:521–533CrossRefGoogle Scholar
  30. Hovens GC, Stokkel MP, Kievit J, Corssmit EP, Pereira AM, Romijn JA, Smit JW (2007) Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J Clin Endocrinol Metab 92:2610–2615PubMedCrossRefGoogle Scholar
  31. Iyer NG, Morris LG, Tuttle RM, Shaha AR, Ganly I (2011) Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer 117:4439–4446PubMedCentralPubMedCrossRefGoogle Scholar
  32. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, Cooper DS, Haugen BR, Ladenson PW, Magner J, Robbins J, Ross DS, Skarulis M, Maxon HR, Sherman SI (2006) Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid 16:1229–1242PubMedCrossRefGoogle Scholar
  33. Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, Zhang Y, Bai Y, Zhu C, Guo GL, Rothman N, Zhang Y (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20:525–531PubMedCentralPubMedCrossRefGoogle Scholar
  34. Kloos RT, Mazzaferri EL (2005) A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab 90:5047–5057PubMedCrossRefGoogle Scholar
  35. Ladenson PW, Braverman LE, Mazzaferri EL, Brucker-DavisF, Cooper DS, Garber JR, Wondisford FE, Davies TF, DeGrootLJ, Daniels GH, Ross DR, Weintraub BD (1997) Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning inpatients with thyroid carcinoma. N Engl J Med 337:888–896Google Scholar
  36. Lal G, O’Dorisio T, McDougall R, Weigel RJ ( 2008) Cancer of the head and neck. In: Abeloff MD, Armitage JO, NiederhuberJE, Kastan MB, McKenna WG (eds) Abeloff’s clinical oncology. Churchill Livingstone Elsevier, Philadelphia, p 148Google Scholar
  37. Lang BH, Lo CY, Chan WF, Lam KY, Wan KY (2007) Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg 245:366–378PubMedCentralPubMedCrossRefGoogle Scholar
  38. Li N, Du XL, Reitzel LR, Xu L, Sturgis EM (2013) Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the Surveillance, Epidemiology, and End Results registry, 1980–2008. Thyroid 23:103–110PubMedCentralPubMedCrossRefGoogle Scholar
  39. Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, Nicol A, Clark PM, Farnell K, McCready R, Smellie J, Franklyn JA, John R, Nutting CM, Newbold K, Lemon C, Gerrard G, Abdel-Hamid A, Hardman J, Macias E, Roques T, Whitaker S, Vijayan R, Alvarez P, Beare S, Forsyth S, Kadalayil L, Hackshaw A (2012) Ablation with low-dose radioiodine and thyrotropin Alfa in thyroid cancer. N Engl J Med 366:1674–1685PubMedCrossRefGoogle Scholar
  40. Mazzaferri E (2004) A randomized trial of remnant ablation—in search of an impossible dream? J Clin Endocrinol Metab 89:3662–3664PubMedCrossRefGoogle Scholar
  41. Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428PubMedCrossRefGoogle Scholar
  42. Mazzaferri EL, Kloos RT (2001) Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463PubMedCrossRefGoogle Scholar
  43. McCowen KD, Adler RA, Ghaed N, Verdon T, Hofeldt FD (1976) Low dose radioiodine thyroid ablation in postsurgical patients with thyroid cancer. Am J Med 61(52–58):1976Google Scholar
  44. Meier CA, Braverman LE, Ebner SA, Veronikis I, Daniels GH, Ross DS, Deraska DJ, Davies TF, Valentine M, DeGroot LJ, Curran P, McEllin K, Reynolds J, Robbins J, Weintraub BD (1994) Diagnostic use of recombinant human thyrotropin inpatients with thyroid carcinoma (phase I/II study). J Clin Endocrinol Metab 78:188–196PubMedGoogle Scholar
  45. Morris LF, Wilder MS, Waxmann AD, Braunstein GD (2001) Reevaluation of the impact of a stringent low-iodine diet on ablation rates in radioiodine treatment of thyroid carcinoma. Thyroid 11: 749–755Google Scholar
  46. Pacini F, Molinaro E, Castagna MG, Agate L, Elisei R, Ceccarelli C, Lippi F, Taddei D, Grasso L, Pinchera A (2003) Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab 88:3668–3673PubMedCrossRefGoogle Scholar
  47. Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL (2004) Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg 130:819–824PubMedCrossRefGoogle Scholar
  48. Park JT, Hennessey JV (2004) Two-week low iodine diet is necessary for adequate outpatient preparation for radioiodine rhTSH scanning in patients taking levothyroxine. Thyroid 14:57–63PubMedCrossRefGoogle Scholar
  49. Pelizzo MR, Boschin IM, Toniato A, Piotto A, Bernante P, Pagetta C, Rampin L, Rubello D (2006) Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J SurgOncol 32:1144–1148Google Scholar
  50. Pilli T, Brianzoni E, Capoccetti F, Castagna MG, Fattori S, Poggiu A, Rossi G, Ferretti F, Guarino E, Burroni L, Vattimo A, Cipri C, Pacini F (2007) A comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-iodine administered doses for recombinant thyrotropin-stimulated postoperative thyroid remnant ablation in differentiated thyroid cancer. J Clin Endocrinol Metab 92:3542–3546PubMedCrossRefGoogle Scholar
  51. Pluijmen MJ, Eustatia-Rutten C, Goslings BM, Stokkel MP, Arias AM, Diamant M, Romijn JA, Smit JW (2003) Effects of low-iodide diet on post surgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma. Clin Endocrinol 58:428–435CrossRefGoogle Scholar
  52. Podnos YD, Smith D, Wagman LD, Ellenhorn JD (2005) Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery 138:1072–1076PubMedCrossRefGoogle Scholar
  53. Podnos YD, Smith DD, Wagman LD, Ellenhorn JD (2007) Survival in patients with papillary thyroid cancer is not affected by the use of radioactive isotope. J Surg Oncol 96:3–7PubMedCrossRefGoogle Scholar
  54. Robbins RJ, Tuttle RM, Sonenberg M, Shaha A, Sharaf R, Robbins H, Fleisher M, Larson SM (2001) Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin. Thyroid 11:865–869PubMedCrossRefGoogle Scholar
  55. Rubino C, de Vathaire F, Dottorini ME, Hall P, Schvartz C, Couette JE, Dondon MG, Abbas MT, Langlois C, Schlumberger M (2003) Second primary malignancies in thyroid cancer patients. Br J Cancer 89:1638–1644PubMedCentralPubMedCrossRefGoogle Scholar
  56. Sacks W, Fung CH, Chang JT, Waxman A, Braunstein GD (2010) The effectiveness of radioactive iodine for treatment of low-risk thyroid cancer: a systematic analysis of the peer-reviewed literature from 1966 to April 2008. Thyroid 20:1235–1245PubMedCrossRefGoogle Scholar
  57. Samaan NA, Maheshwari YK, Nader S, Hill CS Jr, Schultz PN, Haynie TP, Hickey RC, Clark RL, Goepfert H, Ibanez ML, Litton CE (1983) Impact of therapy for differentiated carcinoma of the thyroid: an analysis of 706 cases. Clin Encocrinol Metab 56:1131–1138CrossRefGoogle Scholar
  58. Sawka AM, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein HC (2004) Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab 89:3668–3676PubMedCrossRefGoogle Scholar
  59. Sawka AM, Brierley JD, Tsang RW, Thabane L, Rotstein L, Gafni A, Straus S, Goldstein DP (2008) An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer. Endocrinol Metab Clin N Am 37:457–480CrossRefGoogle Scholar
  60. Sawka AM, Thabane L, Parlea L, Ibrahim-Zada I, Tsang RW, Brierley JD, Straus S, Ezzat S, Goldstein DP (2009) Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 19:451–457PubMedCrossRefGoogle Scholar
  61. Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Jarzab B, Limbert E, Lind P, Pacini F, Reiners C, Sanchez Franco F, Toft A, Wiersinga WM (2004) Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 150:105–112Google Scholar
  62. Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, Bardet S, Leenhardt L, Bastie D, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Bonichon F, Dejax C, Toubert ME, Leboulleux S, Ricard M, Benhamou E (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366:1663–1673PubMedCrossRefGoogle Scholar
  63. Schvartz C, Bonnetain F, Dabakuyo S, Gauthier M, Cueff A, Fieffé S, Pochart JM, Cochet I, Crevisy E, Dalac A, Papathanassiou D, Toubeau M (2012) Impact of overall survival of radioiodine in low-risk DTC patients. J Clin Endocrinol Metab 97: 1526–1535Google Scholar
  64. Shaha AR (2004) Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope 114:393–402PubMedCrossRefGoogle Scholar
  65. Simpson WJ, Panzarella T, Carruthers JS, Gospodarowicz MK, Sutcliffe SB (1988) Papillary and follicular thyroid cancer: impact of treatment in 1578 patients. Int J Radiat Oncol Biol Phys 14:1063–1075PubMedCrossRefGoogle Scholar
  66. Snyder J, Gorman C, Scanlon P (1983) Thyroid remnant ablation: Questionable pursuit of an ill-defined goal. J Nucl Med 24:659–665PubMedGoogle Scholar
  67. Tomoda C, Uruno T, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K, Miyauchi A (2005) Reevaluation of stringent low iodine diet in outpatient preparation of radio- iodine examination and therapy. Endocr J 52:237–240PubMedGoogle Scholar
  68. Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G, D’Azzo` G, Meringolo D, Ferretti E, Sacco R, Arturi F, Filetti S (2004). Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab 89:3402–3407Google Scholar
  69. Van Nostrand D, Aiken M, Atkins F, Moreau S, Garcia C, Acio E, Burman K, Wartofsky L (2009) The utility of radioiodine scans prior to 131I ablation in patients with well differentiated thyroid cancer. Thyroid 19:849–855PubMedCrossRefGoogle Scholar
  70. Verburg FA, Mäder U, Tanase K, Thies ED, Diessl S, Buck AK, Luster M, Reiners C (2013) Life expectancy is reduced in differentiated thyroid cancer patients >45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients. J Clin Endocrinol Metab 98:172–180PubMedCrossRefGoogle Scholar
  71. WHO, UNICEF, ICCIDD (2001) Assessment of the iodine deficiency disorders and monitoring their elimination. World Health Organisation, 2001. WHO Document WHO/NHD/01.1Google Scholar

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© Springer-Verlag Berlin Heidelberg  2013

Authors and Affiliations

  1. 1.Department of Nuclear MedicineAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of Nuclear Medicine & PETSingapore General HospitalSingaporeSingapore

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