Should We Routinely Offer a Second Admission for Radioiodine to Patients with High-risk Differentiated Thyroid Cancer?

Abstract 

Aims

To assess whether an elective second admission for radioiodine is useful for patients with high-risk differentiated thyroid cancer (DTC).

Materials and methods

A retrospective analysis was carried out on 47 high-risk DTC patients treated with a second admission for radioiodine at our centre during the 2007–2008 period.

Results

In 21 patients (45%), the surgeon described an incomplete resection. Twenty-six (55%) had surgical macroscopic complete resection, but cancer cells at the margin of excision histologically. Overall, at the second admission for radioiodine, 27 patients (57%) had a normal post-treatment scan and undetectable thyroid-stimulating hormone (TSH) stimulated thyroglobulin. Twenty patients (43%) had raised stimulated thyroglobulin at second admission for radioiodine, of whom only six (13%) had abnormal uptake (>0.1%) on the post-treatment scan.

Conclusions

A second admission for radioiodine could have been avoided in most patients. Instead, information from stimulated thyroglobulin and a diagnostic radioiodine scan would have been sufficient to guide further management. This study also provides interesting outcome data on incompletely resected DTC.

Key words: High-risk DTC, postoperative residual cancer, radioiodine, radiotherapy, raised thyroglobulin, thyroid cancer