Radioactive Iodine Following Total Thyroidectomy Is Comparable to Lobectomy in Low/Intermediate-Risk Differentiated Thyroid Carcinoma: A Meta-Analysis.

Radioactive iodine (RAI) is being increasingly used for remnants ablation of low/intermediate-risk differentiated thyroid carcinoma (DTC). Importantly, total thyroidectomy (TT) is in common use in the treatment of low-grade DTC to facilitate RAI despite the recommendations for lobectomy. Intermediate-risk DTC has been an arena of controversy (fueled by weighing the risks and benefits of RAI). This meta-analysis aimed to assess the role of RAI following TT in comparison to lobectomy in low/intermediate-risk patients with DTC. We identified 482 references through PubMed, Cochrane Library, EBSCO, and Google Scholar databases. The keywords used were "differentiated thyroid carcinoma", "low/intermediate risk", "radioactive iodine following total thyroidectomy", "total thyroidectomy versus lobectomy and RAI", "remnants ablation", "recurrence", "survival rate", "tumor-specific cancer death", "overall mortality", and "tumor-specific mortality". From the 67 full texts screened, only seven studies fulfilled the inclusion and exclusion criteria. The studies were from the USA, Australia, Asia, Mexico, and South America (63,268 patients included; five were retrospective and two prospective cohorts). No differences were found regarding recurrence and survival rate between TT followed by RAI and lobectomy alone. However, the current data were limited by the observational studies included, the pooling of both recurrence and survival rate, and the significant heterogeneity observed. The ongoing randomized controlled trials are awaited to resolve the issue.