title: Implications of mediastinal uptake of 131I with regard to surgery in patients with differentiated thyroid carcinoma.
abstract: BACKGROUND
  Findings of mediastinal uptake of 131I after surgical treatment for differentiated thyroid carcinoma (DTC) are common, especially in young patients. Given the frequency of false-positive findings, a protocol for diagnostic and therapeutic strategies would be useful. With the goal of accurately selecting management strategies, the authors analyzed their data and data found elsewhere in the literature for correlations with the incidence of mediastinal 131I uptake and with treatment for patients exhibiting such 131I uptake.
  
  
  METHODS
  All patients with DTC who were treated between 1978 and 2000 at Groningen University Hospital (Groningen, The Netherlands) and who received adjuvant 131I ablation therapy were included in the current analysis, which involved retrospective review of all relevant data.
  
  
  RESULTS
  Five hundred four patients with DTC initially underwent total thyroidectomy, with additional 131I ablation performed for 489 of these patients. In 48 of 489 patients (9.8%), 131I uptake was seen in the mediastinum on a posttreatment scan. Analysis of those 48 patients and of cases in the literature demonstrated that serum thyroglobulin levels, risk status, and the presence of thymus on radiologic images were important in the surgical decision-making process.
  
  
  CONCLUSIONS
  Mediastinal uptake of 131I on posttreatment scans was found in approximately 10% of patients after total thyroidectomy for DTC. Based on the current data and the data presented in the literature, the authors developed a flow chart for determining appropriate treatment strategies, which included mediastinal dissection for high-risk patients and for patients with serum thyroglobulin levels > 10 ng/mL.
authors.affiliation: Department of Surgery, Groningen University Hospital, Groningen, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Haveman
authors.forename: Ha T T
authors.initials: HT
authors.lastname: Phan
authors.forename: Thera P
authors.initials: TP
authors.lastname: Links
authors.forename: Piet L
authors.initials: PL
authors.lastname: Jager
authors.forename: John T M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D003657:Decision Making; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D010347:Patient Care Planning; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes