The use of radioiodine in the management of the differentiated tyroid cancer

Abstract

The use of radioactive iodine (¹³¹I) has substantially improved the prognosis of the differentiated thyroid cancer (DTC); however, its use can be effective only if it is planned with a precise strategy. A “radical” protocol of treatment is described, involving surgical “near total” thyroidectomy, followed by an “ablative” treatment with radioiodine. A total body (TB) scan is performed just after the treatment and, if it is negative, is repeated later with a tracer dose, in order to detect functioning distant metastases, if any, suitable for¹³¹I therapy. Out of a series of 202 patients affected by DTC, several cases (from 9 to 37%, depending on initial stage), who were apparently free of metastases on clinical and radiological basis, resulted positive for functioning metastases not known before, involving lungs, or lymph-nodes, or bones. Patients whose metastases had been discovered only by scan were successfully cured in larger numbers and with lesser amount of radioiodine, compared with others whose metastases were already known on clinical or radiological grounds. Side effects of the treatment were minimal, and not disproportionate to the disease. Patients administered with radioiodine in therapeutic dosage were admitted to the hospital in a special restricted area. Waste handling facilities are described.