J Korean Med Sci.  2015 Jul;30(7):876-881. 10.3346/jkms.2015.30.7.876.

Clinical Outcome of Remnant Thyroid Ablation with Low Dose Radioiodine in Korean Patients with Low to Intermediate-risk Thyroid Cancer

• Ha S
• Oh SW
• Kim YK
• Koo DH
• Jung YH
• Yi KH
• Chung JK

• KMID: 2164471
• DOI: http://doi.org/10.3346/jkms.2015.30.7.876

Abstract

Radioiodine activity required for remnant thyroid ablation is of great concern, to avoid unnecessary exposure to radiation and minimize adverse effects. We investigated clinical outcomes of remnant thyroid ablation with a low radioiodine activity in Korean patients with low to intermediate-risk thyroid cancer. For remnant thyroid ablation, 176 patients received radioiodine of 1.1 GBq, under a standard thyroid hormone withdrawal and a low iodine diet protocol. Serum levels of thyroid stimulating hormone stimulated thyroglobulin (off-Tg) and thyroglobulin-antibody (Tg-Ab), and a post-therapy whole body scan (RxWBS) were evaluated. Completion of remnant ablation was considered when there was no visible uptake on RxWBS and undetectable off-Tg (<1.0 ng/mL). Various factors including age, off-Tg, and histopathology were analyzed to predict ablation success rates. Of 176 patients, 68.8% (n = 121) who achieved successful remnant ablation were classified into Group A, and the remaining 55 were classified into Group B. Group A presented with significantly lower off-Tg at the first radioiodine administration (pre-ablative Tg) than those of Group B (1.2 +/- 2.3 ng/mL vs. 6.2 +/- 15.2 ng/mL, P = 0.027). Pre-ablative Tg was the only significant factor related with ablation success rates. Diagnostic performances of pre-ablative Tg < 10.0 ng/mL were sensitivity of 99.1%, specificity of 14.0%, positive predictive value of 71.1%, and negative predictive value of 87.5%, respectively. Single administration of low radioiodine activity could be sufficient for remnant thyroid ablation in patients with low to intermediate-risk thyroid cancer. Pre-ablative Tg with cutoff value of 10.0 ng/mL is a promising factor to predict successful remnant ablation.

Keyword

Remnant Thyroid Ablation; Radioiodine; Differentiated Thyroid Carcinoma; Thyroglobulin

MeSH Terms

Adolescent
Adult
Aged
Female
Humans
Iodine Radioisotopes/*therapeutic use
Male
Middle Aged
Republic of Korea
Thyroglobulin/blood/immunology
Thyroid Gland/*pathology/*radiation effects
Thyroid Neoplasms/*radiotherapy
Thyrotropin/blood
Treatment Outcome
Young Adult
Iodine Radioisotopes
Thyroglobulin
Thyrotropin

Figure

• 

  Fig. 1 Success rates of remnant ablation according to pre-ablative thyroglobulin (Tg) levels at the first radioiodine therapy. Patients with lower pre-ablative Tg were more likely to achieve remnant ablation than those with higher pre-ablative Tg.

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