Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan.
Department of Radiology, Penn State Health, Hershey, PA, USA.
Endocrine. 2021 Sep;73(3):633-640. doi: 10.1007/s12020-021-02698-x. Epub 2021 Mar 27.
The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the I activity utilized by an academic tertiary hospital in Jordan.
All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and I activity was assigned accordingly. The actual I activity administered was compared with that recommended by the 2015 ATA guidelines.
In total, 135/182 DTC patients (74.2%) managed at JUH underwent I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding I therapy altogether in the 2015 ATA low-risk patients would result in decreasing the I activity in the overall patient population by 37%. Withholding I therapy only in low-risk papillary thyroid microcarcinomas while administering 1.11 GBq of I to other low-risk patients would result in 28% reduction of I.
This study demonstrates a significant reduction in I therapeutic activity that would be given to DTC patients in an academic tertiary setting in Jordan, following acceptance of the 2015 ATA recommendations. Institutions that adopted the 2015 ATA guidance should measure outcomes in comparison to their historical controls and report those findings, while long-term results of randomized controlled trials are forthcoming.
2015 年美国甲状腺协会（ATA）指南呼吁在低危分化型甲状腺癌（DTC）患者中进行更具选择性的碘治疗。我们假设这些指南的应用将显著降低约旦一所学术性三级医院使用的碘活性。
根据 2015 年 ATA 风险类别对 2009 年 1 月至 2019 年 6 月期间在约旦大学医院（JUH）管理的所有 DTC 患者进行分类，并相应分配碘活性。比较实际给予的碘活性与 2015 年 ATA 指南推荐的活性。
共有 182 例 DTC 患者（74.2%）在 JUH 接受了碘治疗。其中，58 例（43%）为 ATA 低危，58 例（43%）为中危，19 例（14%）为高危。低、中、高危 DTC 患者分别接受平均（±SD）初始碘活性 3.53±0.95、4.40±1.49 和 5.06±2.52GBq。如果完全停止 2015 年 ATA 低危患者的碘治疗，将使整个患者群体的碘活性减少 37%。如果仅对 2015 年 ATA 低危的甲状腺微小乳头状癌患者停止碘治疗，而对其他低危患者给予 1.11GBq 的碘治疗，将使碘治疗减少 28%。
本研究表明，在接受 2015 年 ATA 建议后，在约旦的一所学术性三级医院，对 DTC 患者进行的碘治疗活性显著降低。采用 2015 年 ATA 指南的机构应与历史对照物进行比较，并报告结果，同时即将公布随机对照试验的长期结果。
