Department of Surgery, New York Presbyterian/Lower Manhattan Hospital, Weill Cornell Medicine, 156 William Street, 12th Floor New York, NY 10038, USA.
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue New York, NY 10065, USA.
Eur J Surg Oncol. 2018 Mar;44(3):348-356. doi: 10.1016/j.ejso.2017.04.002. Epub 2017 May 3.
A remarkable, evidence-based trend toward de-escalation has reformed the practice of radioactive iodine (RAI) administration for thyroid cancer patients. Updated guidelines have supported both decreased RAI doses for select populations, as well as expanded definitions of low-risk and intermediate-risk patients that may not require RAI. Correspondingly, there is now increased flexibility for hemithyroidectomy without need for RAI, and relaxed TSH suppression targets for low-risk thyroidectomy patients. Clinical judgment remains indispensable where multiple risk factors co-exist that individually are not indications for RAI. This is especially salient in intermediate-risk patients with a less than excellent response to therapy, determined through thyroglobulin and ultrasound surveillance. Such judgment, however, may lead to patterns of inappropriate RAI practices or overuse with little benefit to the patient and unnecessary harm. A multidisciplinary, risk-adapted approach is ever more important and obliges the surgeon to understand the likelihood that their patients will receive RAI. The risks and benefits of RAI, its evolved role in contemporary guidelines, and current patterns of use among endocrinologists are reviewed, as well as the practical implications for thyroid surgeons.
放射性碘 (RAI) 治疗甲状腺癌患者的方案已出现显著的、基于证据的下调趋势，这一趋势改变了实践。更新的指南支持为特定人群减少 RAI 剂量，以及扩大低危和中危患者的定义，这些患者可能不需要 RAI。相应地，对于不需要 RAI 的甲状腺叶切除术，现在有了更大的灵活性，对于低危甲状腺切除术患者，TSH 抑制目标也放宽了。如果存在多种单独不是 RAI 适应证的危险因素，则仍需要临床判断。对于治疗反应不佳的中危患者，通过甲状腺球蛋白和超声监测，这一点尤为明显。然而，这种判断可能导致 RAI 实践的不当模式或过度使用，对患者没有益处，也没有必要造成伤害。多学科、风险适应的方法变得越来越重要，这迫使外科医生了解其患者接受 RAI 的可能性。本文回顾了 RAI 的风险和益处、其在当代指南中的演变作用以及内分泌学家目前的使用模式，以及对甲状腺外科医生的实际影响。
