Thyroid Cancer Coverage from Every Angle

Do All Patients With Papillary Thyroid Cancer Require Radioiodine Therapy?

By: Joshua D. Madera, MS
Posted: Wednesday, August 19, 2020

Radioiodine therapy may not be a necessary intervention for patients with papillary thyroid carcinoma and clinically apparent lymph node metastases (cN1) who have low thyroglobulin in the absence of antithyroglobulin antibodies, according to a prospective study published in Endocrine. These patients did not demonstrate any anomalies on neck ultrasonography after thyroidectomy. “To our knowledge, no studies have evaluated the risk of recurrence in cN1 patients with low thyroglobulin after total thyroidectomy when they were not treated with radioiodine,” reported Maria Regina Calsolari, MD, of Santa Casa de Belo Horizonte, Brazil, and colleagues.

A total of 82 patients with cN1 thyroid carcinoma were enrolled in the study. All patients had tumors up to 4 cm wide without T1 to T2 macroscopic thyroid extravasation and fewer than three lymph node metastases up to 1.5 cm. In addition, all patients had undergone total thyroidectomy and demonstrated unstimulated thyroglobulin levels less than 0.3 ng/mL. Patients also did not have neck anomalies as verified by ultrasonography and had negative antithyroglobulin antibodies. All patients did not receive any radioiodine therapy for the duration of the study.

The investigators reported that without radioiodine treatment, 96.3% of patients continued to demonstrate unstimulated thyroglobulin levels up to 0.3 ng/mL and negative ultrasound results. Moreover, just two patients were identified as having a structural cancer recurrence, and 3.6% of patients demonstrated increased thyroglobulin levels. However, following treatment intervention, they did not reveal any tumors, and their unstimulated thyroglobulin levels decreased to less than 0.1 ng/mL.

Of note, the study authors acknowledged the number of patients was small. The investigators also mentioned they did not compare their findings with those of patients who were treated with radioiodine therapy.

Disclosure: For full disclosures of the study authors, visit


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