title: Is radioiodine administration in patients with papillary thyroid multifocal microcarcinoma unnecessary?
abstract: Radioiodine (RAI) has played a crucial role in differentiated thyroid cancer treatment for more than 60years. However, the use of RAI administration in patients with papillary thyroid microcarcinoma (even multifocal) is now being widely discussed and often not recommended. In accordance with European consensus, and contrary to the American Thyroid Association (ATA) guidelines, we recently performed RAI thyroid remnant ablation in a patient with differentiated papillary multifocal microcarcinoma. The post-therapeutic whole-body scan and SPECT/CT revealed the real and unexpected extent of disease, with metastases to upper mediastinal lymph nodes. This finding led to the patient's upstaging from stage I to stage IVa according to the American Joint Committee on Cancer/International Union Against Cancer criteria.
  
  
  CONCLUSIONS
  (131)I is a combined beta-gamma emitter, thus allowing not only residual thyroid tissue ablation but also metastatic tissue imaging.RAI remnant ablation omission also means post-treatment whole-body scan omission, which may lead to disease underestimation, due to incorrect nodal and metastatic staging.RAI should be considered also in "low-risk" patients, especially when the lymph node involvement is not reliably documented.Lower administered RAI activity (30mCi, 1.1GBq) may be a workable compromise in low-risk patients, not indicated for RAI remnant ablation according to ATA guidelines.
authors.affiliation: Nuclear Medicine Department, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Academic Department of Internal Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Krčálová
authors.affiliation: 4th Department of Internal Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Academic Department of Internal Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Horáček
authors.affiliation: Internal Medicine Department, Hospital Trutnov , Trutnov , Czech Republic.
authors.forename: Lubomír
authors.initials: L
authors.lastname: Kudlej
authors.affiliation: Nuclear Medicine Department, Hospital Trutnov , Trutnov , Czech Republic.
authors.forename: Viera
authors.initials: V
authors.lastname: Rousková
authors.affiliation: Nuclear Medicine Department, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic.
authors.forename: Blanka
authors.initials: B
authors.lastname: Michlová
authors.affiliation: Nuclear Medicine Department, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic.
authors.forename: Irena
authors.initials: I
authors.lastname: Vyhnánková
authors.affiliation: Nuclear Medicine Department, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Doležal
authors.affiliation: 4th Department of Internal Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Academic Department of Internal Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Malý
authors.affiliation: 4th Department of Internal Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Academic Department of Internal Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Žák