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Selective Use of Radioactive Iodine in Intermediate-Risk Papillary Thyroid Cancer


Abstract: The American Thyroid Association (ATA) guidelines endorse the selective use of postoperative radioactive iodine (RAI) in all patients with well-differentiated thyroid cancer (WDTC) greater than 1 cm in greatest dimension and go on to recommend the routine use of RAI in patients with advanced local disease (pT3 or pT4) irrespective of age.1 Despite these recommendations, the guidelines highlight the conflicting data particularly in relation to patients with less aggressive local disease. Based on clinical and histopathologic features, all WDTC cases can be classified into low-, intermediate-, and high-risk groups for death based on the Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York, previously published risk stratification system GAMES (Table 1).2 In this system, patients younger than 45 years who present with papillary carcinomas smaller than 4 cm in greatest dimension and confined to the thyroid gland (intraglandular), without evidence of distant metastatic disease, are considered at low risk of death. Patients older than 45 years with extrathyroid extension (ETE), aggressive histopathologic features, disease larger than 4 cm in greatest dimension, or distant metastatic disease are at higher risk. Young patients with, or older patients without, aggressive histopathologic features form an intermediate-risk group.3 This intermediate-risk group formed the patient cohort on which our study was based.
Keywords: thyroidectomy / neoplasms / radioactive iodine / thyroid carcinoma / papillary / surgical procedures / operative / thyroid

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