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Radioactive Iodine Therapy of thyroid cancer

General

Nuclear medical examinations play an important part in differentiated thyroid cancer, both for therapy follow-up and for localization of local recurrence. Radioactive iodine is important for postoperative ablation, treatment of small metastases, and diffuse lung metastases. Postoperative radioactive iodine (131I ) therapy is given to patients with a high risk of recurrence after surgery. 

Examinations with radioactive iodine play a small role in the primary work-up of thyroid cancer. The diagnostic total-body scan with 200-700 MBq 131I is no longer performed before therapy, because the diagnostic dose may inhibit the subsequent uptake of the therapeutic dose (stunning), and also because a diagnostic scan has much less sensitivity for detection of remaining tissue compared to a post therapy scan. A diagnostic scan with123I can be utilized without the danger of stunning, but the medication is costly.

A diagnostic scan with131I /123 I in addition to a post-therapy scan can be taken advantageously as a SPECT/CT.

Indications

Differentiated thyroid cancer after a thyroidectomy in the presence of one of the following factors: 

  • solitary papillary thyroid carcinoma 1-2 cm in largest diameter 
  • multifocal papillary thyroid carcinoma
  • papillary cancer with metastases to regional lymph nodes
  • papillary cancer with extra thyroidal growth and vessel infiltration and with Tall cell variant
  • invasive follicular cancer with or without regional or distant metastasis 
  • minimally invasive follicular cancer > 4 cm
  • minimally invasive follicular cancer with regional or distant metastases. Generally more liberal for patients between 20-45 years and with Hûrthle cell variation. 
  • iodine-concentrating metastases
  • diffuse lung metastases

Goal

Postoperative diagnostics

  • Inspect whether there is surrounding iodine contentrating tissue concentrated in the neck, or if there is iodine-concentrating in metastases.

Postoperative radioactive iodine therapy

  • Ablation of remaining thyroid tissue to better monitor the level of s-tyroglobulin.
  • Minimize the frequency of recurrence by ablation of microscopic remains of cancer tissue.
  • Treatment for metastases.

Treatment for metastasis

  •  Ablation of metastases (iodine-concentrating)

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