Adjuvant therapy with 131-iodine in patients with elevated serum thyroglobulin after reoperation due to papillary thyroid carcinoma lymph node metastases

Excerpt

After initial therapy of papillary thyroid carcinoma (PTC), persistence or recurrence of the tumor is observed in up to 30 % of patients, particularly lymph node metastases (LNM) not accompanied by distant disease [1, 2]. The management of these patients has been extensively discussed [2]. Although expectant management (selected cases) and other therapies (¹³¹I, external radiotherapy, percutaneous ethanol injection [3]) are possible, surgery continues to be a frequent recommendation [2]. Most patients with LNM undergoing reoperation do not show apparent disease detected by imaging methods after this procedure [2], but serum thyroglobulin (Tg) continues to be elevated in part of them [2]. It is reasonable to imagine that the persistence of elevated Tg after reoperation in patients who had been submitted to total thyroidectomy and remnant ablation is an indicator of the presence of metastases. In fact, the risk of second recurrence is high in these cases [4‐6]. Taken together, these facts favor adjuvant therapy with ¹³¹I, but so far only one study evaluated the role of this therapy in 23 patients with elevated Tg after reoperation due to LNM and found no benefit [2, 5]. …