title: Indications for radioiodine administration in follicular-derived thyroid cancer.
abstract: Indications for radioiodine administration after thyroid cancer surgery have shifted in recent years toward personalized management, adapted to the individual risk of tumor progression. The most recent guidelines and studies favor de-escalation in indications for administration, dosage and means of preparation with exogenous recombinant TSH stimulation as treatment of choice. Radioiodine administration has 3 possible objectives: • ablation of normal thyroid tissue remnants in patients with low risk of progression, using low radioiodine activity levels, with the advantage of completing disease staging on whole-body scintigraphy performed after administration of the radioiodine capsule, and of facilitating follow-up by thyroglobulin assay; • adjuvant treatment for suspected microscopic metastases in patients with intermediate or high risk of progression, using higher activity levels, with the theoretic aim of limiting recurrence and mortality; • curative treatment in high-risk patients with proven metastases, using exclusively high activity levels, with a view to improving specific survival. In future, indications for ablation and/or activity prescription may be governed by an algorithm incorporating individual baseline progression risk (essentially founded of pTNM staging) and postoperative data such as thyroglobulin level and neck ultrasound results.
authors.affiliation: Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Buffet
authors.affiliation: Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ghander
authors.affiliation: Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: le Marois
authors.affiliation: Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France. Electronic address: laurence.leenhardt@psl.aphp.fr.
authors.forename: L
authors.initials: L
authors.lastname: Leenhardt
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors
chemical_list: D007457:Iodine Radioisotopes
keywords: Ablation; Activité; Radioiodine activity; Remnant ablation; Risk-stratification; Stratification du risque; TSH recombinante; rhTSH