Jaiswal Gayatri, Grimes Michael, Bononi Patricia, Vaghasia Nishit, Khan Saira, Andre Kersthine, Dharia Ashni, Alkhaddo Jamil
Center for Diabetes and Endocrine Health, Allegheny Health Network, Medicine Institute, Pittsburgh, PA 15017, USA.
Division of Internal Medicine, Allegheny Health Network, Medicine Institute, Pittsburgh, PA 15212, USA.
J Endocr Soc. 2025 Aug 4;9(9):bvaf128. doi: 10.1210/jendso/bvaf128. eCollection 2025 Sep.
There is an evolving role for radioactive iodine (RAI) in thyroid cancer treatment. Radioactive iodine treatment usually involves a pre-RAI whole-body iodine scan and a posttherapy scan. The clinical utility of pre-RAI therapy scans has been increasingly questioned.
To evaluate the clinical utility of pre-RAI whole-body iodine scans.
We retrospectively reviewed the medical records of differentiated thyroid cancer patients treated with RAI. Using records blinded for pre-RAI scans, 3 endocrinologists developed empiric RAI treatment plans for each patient based on surgical pathology. This was repeated using the unblinded records, and the treatment plans made with and without pre-RAI scan results were compared.
A total of 164 patients met the inclusion criteria: 89 patients (54.3%) were low risk, 61 (37.2%) intermediate risk, and 14 (8.5%) high risk for thyroid cancer recurrence. After blinded review, RAI treatment was recommended for 122 patients (74.3%); 46 were determined to be appropriate for a low-dose RAI, 75 a medium dose, and 1 a high dose. When unblinded, different recommendations were made for only 7 patients (5.7%), with 6 being recommended for a higher RAI dose. In addition, the prescan RAI results prompted recommendations for additional testing, such as neck ultrasounds or computed tomography or postoperative thyroglobulin levels. Pre-RAI scans affected patient care plans in only 7 (5.7%) of the 164 patients in the study.
In most patients with thyroid cancer who may need RAI, pre-RAI scans may not affect management, and empiric RAI doses may be a more cost-effective and convenient option.
放射性碘（RAI）在甲状腺癌治疗中的作用不断演变。放射性碘治疗通常包括治疗前的全身碘扫描和治疗后的扫描。治疗前扫描的临床实用性受到越来越多的质疑。
评估治疗前全身碘扫描的临床实用性。
我们回顾性分析了接受放射性碘治疗的分化型甲状腺癌患者的病历。3名内分泌科医生在不了解治疗前扫描结果的情况下，根据手术病理为每位患者制定经验性放射性碘治疗方案。然后在了解扫描结果的情况下重复这一过程，并比较有和没有治疗前扫描结果时制定的治疗方案。
共有164例患者符合纳入标准：89例（54.3%）为低风险，61例（37.2%）为中风险，14例（8.5%）为甲状腺癌复发高风险。在不知情的情况下进行评估后，建议对122例患者（74.3%）进行放射性碘治疗；确定46例适合低剂量放射性碘治疗，75例适合中等剂量，1例适合高剂量。在了解扫描结果后，只有7例患者（5.7%）的建议不同，其中6例建议使用更高剂量的放射性碘。此外，扫描前的放射性碘结果促使建议进行额外的检查，如颈部超声、计算机断层扫描或术后甲状腺球蛋白水平检测。在该研究的164例患者中，只有7例（5.7%）患者的治疗前扫描影响了患者护理计划。
在大多数可能需要放射性碘治疗的甲状腺癌患者中，治疗前扫描可能不会影响治疗管理，经验性放射性碘剂量可能是一种更具成本效益和便利性 的选择。
