Outpatient thyroid remnant ablation using repeated low 131-iodine activities (740 MBq/20 mCi x 2) in patients with low-risk differentiated thyroid cancer

Abstract

Context: In low-risk differentiated thyroid cancer (DTC), postoperative 131I remnant ablation should employ a minimum effective activity; reports increasingly suggest efficacy of low activities, e.g. 1110 MBq/30 mCi. Objectives, Design, Patients, and Interventions:Weretrospectively studied the ablation capability and diagnostic utility of the Minidose protocol, two 740-MBq/20 mCi outpatient administrations, 6-18 months apart, plus related diagnostic procedures, in 160 consecutive (near-) totally thyroidectomized low-risk DTC (pT1/N0-Nx) patients. Successful ablation comprised negative 740-MBq whole-body scintigraphy with cervical uptake below 0.1%, negative stimulated thyroglobulin (STg) (<1 ng/ml, negative thyroglobulin antibodies), and negative Doppler ultrasonography (performed around Minidose 2). Setting: The study took place at a referral center. Results: Minidose imaging found unsuspected nodal or distant metastases in nine of 160 patients (5.6%). Ablation success rates after one (two) 740-MBq activity (activites) were 75.9% (90.2%) in 145 (132) evaluable imaging-negative patients. Compared with thyroid hormone withdrawal, recombinant human TSH stimulation was associated with higher urinary iodine excretion/creatinine, lower cervical uptake, and more frequent ablation success after the first 740 MBq; success rates no longer differed significantly after both administrations. Patients with STg below 10 ng/ml at Minidose 1 were oftener ablated at Minidose 2 (odds ratio = 13.9, 95% confidence interval =2.5-76.4, P < 0.003), attaining 92.0% final ablation success after recombinant human TSH preparation, suggesting that one 740-MBq activity should suffice in this subgroup. All 81 evaluable patients with prolonged follow-up (mean 41.8 ± 21.9 months after Minidose 1) had no evidence of disease at the last visit. Conclusions: The Minidose outpatient ablation protocol is effective and diagnostically useful in low-risk DTC. Copyright © 2012 by The Endocrine Society.