EP146 – Our experience of Total Thyroidectomy in differentiated thyroid cancer – Is radioiodine ablation necessary postoperatively?

     

    Bhandary, Sangita1; K.C. Abha, Kiran1; Poudel, Deepak1; Chhetri Shyam, Thapa1
    1 Department of Otorhinolaryngology and Head and Neck Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal

     

    Background: After surgery for differentiated thyroid carcinoma, many patients are treated with radioiodine to ablate remnant thyroid tissue. Routine use has been advocated to reduce local recurrence and improve survival. However, economic constraints; lack of accessibility, feasibility and compliance in developing nation like Nepal, often curtails the use of postoperative RIA.This prospective study evaluated the recurrence rate in patients receiving or not receiving postoperative radioiodine ablation for intermediate and high risk Differentiated thyroid cancer who underwent total thyroidectomy with central neck clearance with or without neck dissection.

    Methods: The study included 62 patients undergoing Total Thyroidectomy with (n=20) or without (n= 42) postoperative RIA. Patients were followed up at our centre or community settings. Neck examination followed by neck ultrasound, and chest X-ray were used to assess recurrence.

    Results: Follow-up ranged from 1 to 10 years. All patients continued to present negative neck ultrasound with no evidence of distant metastasis.

    Discussion: Study of 6 decade trend in papillary cancer at Mayo clinic showed no improvement in the already excellent outcome despite the increasing use of radioiodine remnant ablation after bilateral lobar resection. Decision for radioiodine ablation must be individualized, based on risk profile of patient, as well as patient and physician preference. Effectiveness in decreasing locoregional recurrence and distant metastases has been proved in various studies. Routine use has been recommended in high risk cases.

    Conclusion: The actual role of postoperative radioiodine ablation following Total thyroidectomy in intermediate risk patients needs to be established with a larger study with a longer follow-up period.

     

    References:

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    3. Rosario PW, Borges MA, Valadao MM, Vasconcelos FP, Rezende LL, Padrao EL, et al. Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm? Thyroid. 2007;17:1225-8
    4. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-214
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    7. Rosario PW, Mourao GF. Is 131I ablation necessary for patients with low-risk papillary thyroid carcinoma and slightly elevated thyroglobulin after thyroidectomy? Arch EndocrinolMetab 2016;60/1:5-8
    8. Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA. Review: 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. The Journal of Clinical Endocrinology & Metabolism 2007;92(1):28-38

 

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