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Ablation of Nonmalignant Thyroid Remnants with Low Doses of Radioactive Iodine: Concise Communication

Carla Ramacciotti^*, Harold T. Pretorius, Bruce R. Line, Joel M. Goldman and Jacob Robbins

National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases and National Institutes of Health, Bethesda, Maryland

Correspondence: For reprints contact: Jacob Robbins, MD, Bldg. 10, Room 8N315, National Institutes of Health, Bethesda, MD 20205.

ABSTRACT

Remnants of nonmalignant thyroid tissue are nearly always present after surgery performed for thyroid carcinoma, and their ablation with I-131 is associated with decreased recurrence rates and probably increased survival. The usual dose of I-131 is in the range of 50 to 150 mCi; low-dose therapy (30 mCi) has been controversial. We therefore studied the effects of low-dose therapy in 20 patients. Complete ablation of thyroid tissue, as evidenced by negative neck and total-body scans after 6 to 30 mo, using a 1–1.5-mCi test dose, occurred after a single 30-mCi dose in eight patients (40%) and in one of seven patients who were treated again with the same dose. In three of these patients, a minimally positive scan at 6 mo became negative without further therapy. These results (9/15 successful) compared favorably with those of a single 75-mCI dose (6/9 successful). In 19 of the 20 patients, one or two doses of 30 mCi reduced thyroid iodine uptake to a level much less than that of normal nonthyroid neck tissues; i.e., one that causes no significant interference with the diagnosis or therapy of malignant lesions. We conclude that the use of up to two 30-mCi doses at 6-mo Intervals is a reasonable approach to ablation therapy, particularly in young subjects with well-differentiated thyroid cancer. Besides minimizing whole-body and gonadal irradiation exposure, the advantages are greater convenience and reduced expense with a dose that can be given to outpatients. The disadvantages are that about half of the patients will require more treatment, with attendant hypothyroid periods and delay In achieving ablation, and that any tumor in the thyroid remnant may be inadequately irradiated. A long-term, prospective study is needed to evaluate the Importance of these factors. The persistence of a positive scan after two 30-mCi doses appears to be an indication for increasing the subsequent dose, as would the detection of I-131 uptake in tumor tissue at any stage. In older patients (>40 yr) and in poorly differentiated thyroid cancer, high-dose therapy (100 mCi) at the outset may be preferable.

FOOTNOTES

^* Permanent address: Patologia Medica 5^a, Università degli Studi di Pisa, 56100 Pisa, Italy.

Present address: Internal Medicine Clinic, USAF Medical Center, Kessler AFB, MS 39534.

Present address: Nuclear Medicine, Dept. of Radiology, Albany Medical Center Hospital, New Scotland Ave., Albany, NY 12208.

Present address: Dept. of Medicine, Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, NY 11235.

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