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Assessment of the Efficacy of Iodine-131 for Thyroid Ablation

Departments of Medicine and Radio-Oncology, Notre-Dame Hospital, University of Montreal, Quebec, Canada

Correspondence: For correspondence or reprints contact: Ronald Comtois, MD, Notre-Dame Hospital, 1560, Sherbrooke East, Montreal, Quebec, Canada H2L 4M1.

ABSTRACT

It is customary to ablate residual tissue after near-total thyroidectomy for thyroid carcinoma by administering ¹³¹I. A recent trend has been to use lower ¹³¹I doses. This study was designed to assess the efficacy of thyroid ablation by 1110 MBq of ¹³¹I (30 mCi) in patients who had near-total thyroidectomy for papillary, mixed or follicular thyroid carcinoma. Four months after surgery, a whole-body scan was done using 185 MBq (5 mCi) of ¹³¹I after withdrawal of L-thyroxine for 5–6 wk. Residual thyroid area was then measured by planimetry of the thyroid scan. Patients received ablation therapy within 5 days after scanning and one or more subsequent scans were performed 6 mo later. Forty-four patients were treated to ablate residual functional thyroid tissue. Of these, 12 (27%) had successful ablation. Total body areas (1.63 ± 0.16 versus 1.83 ± 0.30, p < 0.03) and residual thyroid tissue (1.4 ± 1.4 versus 2.0 ± 1.2cm², p < 0.05) were less in patients with total thyroid ablation while there was a trend for a smaller incidence of associated goiter in those patients (1/12 versus 13/32, p < 0.07). Nine of the 17 (53%) patients with a total body area less than 1.9 m² and/or with a residual thyroid tissue less than 2.1 cm² and/or without associated previous associated diffuse or multinodular goiter had a total thyroid ablation, while 3 of the 27 (11%) patients who did not have these characteristics had a successful therapy (p < 0.005). Our data suggest that 1110 MBq (30 mCi) of ¹³¹I can achieve total ablation of residual thyroid tissue after near-total thyroidectomy particularly in patients with lower total body area and smaller residual thyroid tissue without associated previous diffuse or multinodular goiter.

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