Postoperative serum thyroglobulin and neck ultrasound to drive decisions about iodine-131 therapy in patients with differentiated thyroid carcinoma: an evidence-based strategy?

Excerpt

Currently a trend towards “de-escalating” the role of adjuvant iodine-131 (¹³¹I) in the treatment of differentiated thyroid cancer can be observed in the community of clinical thyroidology. This trend is however in many respects not based on hard facts but rather an overstretched interpretation of studies not performed with the intention of allowing the derivation of such statements as we and others previously underlined. Given the indolence of thyroid cancer, relative to some other malignancies, outcome measures can only be assessed in the long term. The benefits linked to avoiding adjuvant radioiodine (RAI) therapy in terms of cost or side-effects of treatment should be measured in the long-term considering potential benefits from dynamic re-stratification and reduced surveillance, early detection of residual disease or reduction in the risk of recurrence and associated costs [1]. Finally, different strategies need also to be compared as regards to their ability at providing early reassurance (or counseling) about long-term prognosis and to properly inform the follow-up’s “intensity” [2, 3]. Measurement of serum thyroglobulin (Tg) and neck ultrasound (US) examination were recently proposed as yardsticks for postsurgical management of DTC patients with special emphasis on indications for RAI therapy [4]. The present paper was specifically undertaken to analyze the role and limits of serum Tg and neck US to assess DTC patients after surgery and inform decisions about post-operative RAI administration. …