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2015 ; 14
(3
): 144-55
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Radioiodine Remnant Ablation: A Critical Review
#MMPMID26420983
Bal CS
; Padhy AK
World J Nucl Med
2015[Sep]; 14
(3
): 144-55
PMID26420983
show ga
Radioiodine remnant ablation (RRA) is considered a safe and effective method for
eliminating residual thyroid tissue, as well as microscopic disease if at all
present in thyroid bed following thyroidectomy. The rationale of RRA is that in
the absence of thyroid tissue, serum thyroglobulin (Tg) measurement can be used
as an excellent tumor marker. Other considerations are like the presence of
significant remnant thyroid tissue makes detection and treatment of nodal or
distant metastases difficult. Rarely, microscopic disease in the thyroid bed if
not ablated, in the future, could be a source of anaplastic transformation. On
the other hand, microscopic tumor emboli in distant sites could be the cause of
distant metastasis too. The ablation of remnant tissue would in all probability
eliminate these theoretical risks. It may be noted that all these are unproven
contentious issues except postablation serum Tg estimation that could be a good
tumor marker for detecting early biochemical recurrence in long-term follow-up
strategy. Radioactive iodine is administered as a form of "adjuvant therapy" for
remnant ablation. There have been several reports with regard to the administered
dose for remnant ablation. The first report of a prospective randomized clinical
trial was published from India by a prospective randomized study conducted at the
All India Institute of Medical Sciences, New Delhi in the year 1996. The study
reported that increasing the empirical (131)I initial dose to more than 50 mCi
results in plateauing of the dose-response curve and thus, conventional high-dose
remnant ablation needs critical evaluation. Recently, two important studies were
published: One from French group and the other from UK on a similar line.
Interestingly, all three studies conducted in three different geographical
regions of the world showed exactly similar conclusion. The new era of low-dose
remnant ablation has taken a firm scientific footing across the continents.
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