The guidelines now list RAI as an alternative at 1–12 weeks post thyroidectomy to a total body radioiodine scan.
Clinical indications for RAI are based on pathology, postoperative thyroglobulin, and intraoperative findings.
The recommendations are specific by cancer stage. For example, radioiodine therapy for stage II disease “for the first time is associated with a survival advantage … with total or near-total thyroidectomy,” Dr. Sherman said. “Stage I is the problem. This is the largest group of patients, but overall survival is worse with radioactive iodine therapy.
“Clearly there is no evidence of a benefit among stage I patients. This is a very important pullback in terms of the recommendations,” he said.
“It is our particular opinion at M.D. Anderson that a total body radioiodine scan should be performed prior to treatment because of its diagnostic usefulness,” he added.