The use of radioiodine in the management of the differentiated tyroid cancer

Abstract  The use of radioactive iodine (131I) has substantially improved the prognosis of the differentiated thyroid cancer (DTC); however, its use can be effective only if it is planned with a precise strategy. A “radical” protocol of treatment is described, involving surgical “near total” thyroidectomy, followed by an “ablative” treatment with radioiodine. A total body (TB) scan is performed just after the treatment and, if it is negative, is repeated later with a tracer dose, in order to detect functioning distant metastases, if any, suitable for131I therapy. Out of a series of 202 patients affected by DTC, several cases (from 9 to 37%, depending on initial stage), who were apparently free of metastases on clinical and radiological basis, resulted positive for functioning metastases not known before, involving lungs, or lymph-nodes, or bones. Patients whose metastases had been discovered only by scan were successfully cured in larger numbers and with lesser amount of radioiodine, compared with others ...