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Cancer and Radioiodine Therapy

Last Updated: · Patients
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Question

I underwent a tt last week for what was found to be stage 1 papillary follicular variant carcinoma.  Right lobe 1 lesion 9x5x3mm. Left lobe 2 lesions 1mm and 4mm. Negative nodes. Clear dissection/margins. 7year history of Hashimotos multinodular which was monitored annual by US.  Endo discovered right lobe carcinoma on routine US followed by FNAB.  I’m 41yrs old. No family history of thyroid disease or any autoimmune disorder.  No history of irradiation.  No other health problems, excellent physical health/condition.

I would like to have your opinion on whether RAI ablation would be more beneficial than harmful to me and, if so, what dose you would recommend.  My surgeon said she would do it, even if it had been unifocal.  My endo said he would not, even though it is multifocal, and would monitor by US/TSH.  I am in Wash DC and my doctors are assoc’d w/ Georgetown, George Washington and Washington Hospital Centers.  My endo indicated that if I were at Mayo or Sloan, they would probably advise against RAI.  Washington Hospital Center would be pro RAI.  He said the trend for Stage 1’ers is moving away from routine RAI.  Possible radiation-related consequences outweigh benefits of ablation.  If I am convinced I want it, he suggested a smaller dose.  Is 30mci sufficient for ablation?  I had a skilled surgeon.  Estimated that I may have apx 5 percent thyroid tissue remaining.

Thanks much in advance for your opinion and happy holidays.

Response

Dear Ms

You are in good hands at Georgetown. I would have a radioisotope scan in due course and if there is any uptake in the neck I would have 30mci. This is enough to ablate a trace uptake and should not cause any significant side effects. You are right that my colleagues in the Mayo are generally against giving radioiodine in this situation based on their very long term experience. I would tend to give it in your case because you had multifocality of disease and also i would feel more confident of follow up with measurements of serum thyroglobulin.

Yours sincerely.