title: Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review.
abstract: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the post-operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Blumhardt
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA ely.wolin@us.af.mil lewolin@hotmail.com.
authors.forename: Ely A
authors.initials: EA
authors.lastname: Wolin
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Phillips
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Umber A
authors.initials: UA
authors.lastname: Salman
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Walker
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
authors.affiliation: University of Texas Health Science Center at San AntonioSan Antonio, Texas, USASan Antonio Military Medical CenterSan Antonio, Texas, USATennessee Valley VA Healthcare SystemNashville, Tennessee, USAVanderbilt University Medical CenterNashville, Tennessee, USAUAMS Thyroid CenterUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Metter
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes
keywords: 131I; radioactive iodine therapy; thyroid cancer; thyroid cancer resistance; thyroid cancer staging