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Li D, Zhang G, Li X, Xu S, Sun H, Liu Y, Wu G, Zheng H, Zhang X, Zheng G. Feasibility of Lobectomy in Selected Patients with Unilateral N1b Papillary Thyroid Cancer. Ann Surg Oncol 2025; 32:2344-2352. [PMID: 39645560 PMCID: PMC11882689 DOI: 10.1245/s10434-024-16643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 11/21/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND Total thyroidectomy (TT) is usually recommended for unilateral papillary thyroid cancer (PTC) with lateral lymph node metastasis (LLNM), but no significant improvement in recurrence-free survival (RFS) is seen upon treatment. As an initial surgery, lobectomy may have advantages in appropriately selected unilateral PTC with ipsilateral LLNM. OBJECTIVE This study aimed to explore the feasibility of lobectomy for selected unilateral PTC with ipsilateral LLNM. METHODS From January 2014 to December 2021, we retrospectively reviewed patients with PTC and LLNM who were treated at our center. Patients preoperatively diagnosed with unilateral PTC and ipsilateral LLNM were recruited. Overall, 102 patients who chose lobectomy as their initial surgery were included in the lobectomy group and 96 patients who chose TT were included in the control group, defined as the TT group. RESULTS The mean follow-up time of the lobectomy group was 47.5 ± 22.2 months. Patients in the lobectomy group had a significantly lower rate of hypoparathyroidism than those in the TT group (0% vs. 11.5%; p < 0.001). RFS after lobectomy was comparable with that after TT according to Kaplan-Meier curve analysis (log-rank p = 0.80). Lobectomy achieved a significantly lower incidence of unsatisfactory TSH control than TT (5.9% vs. 20.8%; p = 0.006). CONCLUSIONS Lobectomy may be an appropriate initial therapy for selected unilateral PTC with ipsilateral LLNM. A randomized prospective study with long-term follow-up is warranted.
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Affiliation(s)
- Danxia Li
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Guojun Zhang
- Department of Breast and Thyroid Surgery, Changle People's Hospital, Weifang, China.
| | - Xinna Li
- Department of Pathology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Shuo Xu
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Haiqing Sun
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yang Liu
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Guochang Wu
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Haitao Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
| | - Xiaoli Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
| | - Guibin Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
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Odil EE, Ward KR, Davis RT, Reilly JM, Sun F, Elassar H, Lapkus M, Pastewski J, Studzinski DM, Callahan RE, Czako PF, Nagar S. Radioactive iodine therapy dose impact on recurrence and survival in N1 papillary thyroid cancer. Nucl Med Commun 2025; 46:113-119. [PMID: 39604284 DOI: 10.1097/mnm.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
OBJECTIVE The objective of this study is to investigate radioactive iodine therapy (RAIT) dose impact on survival and recurrence in patients with papillary thyroid cancer (PTC) with regional lymph node metastasis (N1). METHODS A retrospective study of PTC patients with N1 disease from 2007 to 2011 at a tertiary academic hospital collected demographics, tumor characteristics, and RAIT treatment dose. RAIT dose was stratified by total dosage less than or greater than 150 mCi. Outcomes included recurrence, immediate RAIT side-effects, and mortality. RESULTS A total of 60 N1a and 21 N1b patients were studied with a median follow-up of about 9 years. No statistically significant differences were found between N1a PTC patients who received high-dose vs low-dose RAIT in recurrence rate (6.9% vs 6.7%, P > 0.999) or immediate RAIT side effects (6.9% vs 16.1%, P = 0.426). There were no mortalities in the N1a group. For patients with N1b PTC, there were no differences between high-dose and low-dose RAIT in recurrence rate (41.7% vs 44.4%, P > 0.999), mortality (0% vs 16.7%, P = 0.375), or immediate RAIT side effects (8.3% vs 11.1%, P > 0.999). CONCLUSION Dosages of RAIT ≥ 150 mCi do not appear to provide additional benefit in reducing recurrence compared to doses <150 mCi for N1a or N1b PTC patients. No differences in mortality or immediate RAIT side effects were observed between the two dosing regimens; however, interpretation is limited by low event rates. Large randomized trials are needed for further individualized recommendations regarding optimal RAIT dosage in N1 PTC.
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Affiliation(s)
- Elizabeth E Odil
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Katelyn R Ward
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Ryan T Davis
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Jordan M Reilly
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Fionna Sun
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Heba Elassar
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Morta Lapkus
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Jacquelyn Pastewski
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Diane M Studzinski
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Rose E Callahan
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
| | - Peter F Czako
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Sapna Nagar
- Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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do Prado Padovani R, Duarte FB, Nascimento C. Current practice in intermediate risk differentiated thyroid cancer - a review. Rev Endocr Metab Disord 2024; 25:95-108. [PMID: 37995023 DOI: 10.1007/s11154-023-09852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Although the overall prognosis for differentiated thyroid cancer (DTC) is excellent, a subset of patients will experience disease recurrence or may not respond to standard treatments. In recent years, DTC management has become more personalized in order to enhance treatment efficacy and avoid unnecessary interventions.In this context, major guidelines recommend post-surgery staging to assess the risk of disease persistence, recurrence, and mortality. Consequently, risk stratification becomes pivotal in determining the necessity of postoperative adjuvant therapy, which may include radioiodine therapy (RIT), the degree of TSH suppression, additional imaging studies, and the frequency of follow-up.However, the intermediate risk of recurrence is a highly heterogeneous category that encompasses various risk criteria, often combined, resulting in varying degrees of aggressiveness and a recurrence risk ranging from 5 to 20%. Furthermore, there is not enough long-term prognosis data for these patients. Unlike low- and high-risk DTC, the available literature is contradictory, and there is no consensus regarding adjuvant therapy.We aim to provide an overview of intermediate-risk differentiated thyroid cancer, focusing on criteria to consider when deciding on adjuvant therapy in the current context of personalized approach, including molecular analysis to enhance the accuracy of patient management.
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Affiliation(s)
- Rosalia do Prado Padovani
- Section of Endocrinology and Metabolism, Department of Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, , 61 - SAO PAULO -CEP, São Paulo, 1221020, Brazil.
| | - Fernanda Barbosa Duarte
- Section of Endocrinology and Metabolism, Department of Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, , 61 - SAO PAULO -CEP, São Paulo, 1221020, Brazil
| | - Camila Nascimento
- Nuclear Medicine Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
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Pinheiro RA, Leite AK, Cavalheiro BG, de Mello ES, Kowalski LP, Matos LL. Incidental Node Metastasis as an Independent Factor of Worse Disease-Free Survival in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15030943. [PMID: 36765899 PMCID: PMC9913150 DOI: 10.3390/cancers15030943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) have high node metastasis rates. Occasionally after thyroidectomy, the pathological report reveals node metastasis unintentionally resected. The present study aimed to evaluate the prognosis of these patients. METHODS A retrospective cohort of patients submitted to thyroidectomy with or without central compartment neck dissection (CCND) due to PTC with a minimum follow-up of five years. RESULTS A total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37 pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node metastasis were younger, had larger tumors, higher rates of microscopic extra-thyroidal extension, and angiolymphatic invasion and most received radioiodine therapy. Treatment failure was higher in patients pN1a-incidental and pN1a-CCND (32% and 16%, respectively; p < 0.001-Chi-square test). Disease-free survival (DFS) was lower in patients pN1a-incidental compared to patients Nx and pN0-incidental (p < 0.001 vs. Nx and pN0-incidental and p = 0.005 vs. pN0-CCND) but similar when compared to patients pN1a-CCND (p = 0.091)-Log-Rank test. Multivariate analysis demonstrated as independent risk factors: pT4a (HR = 5.524; 95%CI: 1.380-22.113; p = 0.016), pN1a-incidental (HR = 3.691; 95%CI: 1.556-8.755; p = 0.003), microscopic extra-thyroidal extension (HR = 2.560; 95%CI: 1.303-5.030; p = 0.006) and angiolymphatic invasion (HR = 2.240; 95%CI: 1.077-4.510; p = 0.030). CONCLUSION Patients that were pN1a-incidental were independently associated with lower DFS.
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Affiliation(s)
- Renan Aguera Pinheiro
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Correspondence: ; Tel.: +55-11-3069-6425; Fax: +55-11-3069-7506
| | - Ana Kober Leite
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil
| | - Beatriz Godoi Cavalheiro
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Evandro Sobroza de Mello
- Pathology Department, Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil
- Laboratório de Investigação Médica 14 (LIM14), Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil
- Laboratório de Investigação Médica 28 (LIM28), Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
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Zhao H, Gong Y. Radioactive iodine in low- to intermediate-risk papillary thyroid cancer. Front Endocrinol (Lausanne) 2022; 13:960682. [PMID: 36034423 PMCID: PMC9402902 DOI: 10.3389/fendo.2022.960682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/21/2022] [Indexed: 11/22/2022] Open
Abstract
It remains controversial whether papillary thyroid cancer (PTC) patients with low- to intermediate-risk disease should receive radioactive iodine (RAI) after total thyroidectomy (TT). We aim to identify those who might benefit from RAI treatment in PTC patients with cervical nodal metastasis after TT. Patients were divided into TT and TT+RAI groups from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018). Overall survival (OS) and cancer-specific survival (CSS) were compared, and propensity score matching (PSM) was performed between groups. A total of 15,179 patients were enrolled, including 3,387 (22.3%) who underwent TT and 11,792 (77.7%) who received TT+RAI. The following characteristics were more likely to present in the TT+RAI group: multifocality, capsular extension, T3, N1b, and more metastatic cervical lymph nodes. RAI was associated with better OS in low- to intermediate-risk PTC patients in the multivariate Cox regression model. The subgroup analysis showed that RAI predicted better OS in patients ≥55 years, American Joint Committee on Cancer (AJCC) stage II, and capsular extension with a hazard ratio (HR) (95% CI) of 0.57 (0.45-0.72), 0.57 (0.45-0.72), and 0.68 (0.51-0.91), respectively. However, RAI failed to improve the prognoses of patients with age <55 years, AJCC stage I, PTC ≤1 cm, and capsular invasion. In the PSM cohort with 3,385 paired patients, TT+RAI treatment predicted better OS compared with TT alone. In addition, TT+RAI predicted better OS in patients with metastatic cervical lymph nodes ≥2, multifocality, extracapsular extension, and American Thyroid Association (ATA) intermediate risk. In conclusion, RAI was associated with better OS in low- to intermediate-risk PTC patients with age ≥55 years, multifocality, extrathyroidal extension, and ATA intermediate risk. However, the survival benefit from RAI may be limited in patients with AJCC stage I, PTC ≤1 cm, unifocality, capsular invasion, and ATA low-risk diseases; these patients even showed pathological cervical lymph node metastasis.
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Affiliation(s)
| | - Yiping Gong
- *Correspondence: Hengqiang Zhao, ; Yiping Gong,
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6
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Han K, Noh HM, Jeong HM, Lim YC. Is Postoperative Adjuvant Radioactive Iodine Ablation Therapy Always Necessary for Intermediate-Risk Papillary Thyroid Cancer Patients With Central Neck Metastasis? Ann Surg Oncol 2021; 28:7533-7544. [PMID: 34043093 DOI: 10.1245/s10434-021-10164-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is commonly associated with neck lymph node metastasis (LNM), and recurrence does occur after radioactive iodine (RAI) ablation therapy. This study aimed to analyze the effectiveness of RAI ablation with regard to disease recurrence in intermediate-risk PTC patients with neck LNM. In addition, the study identified possible predisposing risk factors that might benefit from RAI ablation and analyzed common RAI therapy complications among these patients. METHODS A retrospective analysis of 349 intermediate-risk PTC patients with neck LNM who underwent thyroidectomy with neck dissection was performed. The oncologic results and clinicopathologic characteristics of these patients together with the incidence of postoperative RAI therapy complications were evaluated. RESULTS Of the 349 patients, disease recurrence after treatment occurred for 27 patients (8%) during a mean follow-up period of 58.7 months (range 7-133 months). The recurrence-free survival curve of the patients who received postoperative RAI therapy (n = 208) did not differ significantly from that of the patients who did not receive it (n = 141) (P = 0.567). Nine patients without adjuvant RAI therapy (6%, 9/141) had recurrence. The recurrence rate for the central LNM patients without RAI therapy was only 2% (2/106). Both of these patients with recurrence had pathologic extranodal spread (ENS) and a high number (> 5) of metastatic central LNs. Postoperative RAI-related complications were observed in 24 patients (12%). CONCLUSIONS Postoperative RAI is not necessary for intermediate-risk papillary thyroid cancer patients with central LNM, especially for patients with negative ENS and low number (< 5) of metastatic lymph nodes.
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Affiliation(s)
- Kyujin Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Min Noh
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Young Chang Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
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7
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ÖZden S, çomçalι BÜL, Ataş H, Er S, Tez M, Saylam B. A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer. Am Surg 2020. [DOI: 10.1177/000313482008600335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis ( P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09–13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.
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Affiliation(s)
- Sabri ÖZden
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - BÜLent çomçalι
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hakan Ataş
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sadettin Er
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mesut Tez
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Barιş Saylam
- From the Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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9
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Wang LY, Ganly I. Nodal metastases in thyroid cancer: prognostic implications and management. Future Oncol 2016; 12:981-94. [PMID: 26948758 PMCID: PMC4992997 DOI: 10.2217/fon.16.10] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
The significance of cervical lymph node metastases in differentiated thyroid cancer has been controversial and continues to evolve. Current staging systems consider nodal metastases to confer a poorer prognosis, particularly in older patients. Increasingly, the literature suggests that characteristics of the metastatic lymph nodes such as size and number are also prognostic. There is a growing trend toward less aggressive treatment of low-volume nodal disease. The aim of this review is to summarize the current literature and discuss prognostic and management implications of lymph node metastases in differentiated thyroid cancer.
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Affiliation(s)
- Laura Y Wang
- Department of Surgery, Head & Neck Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ian Ganly
- Department of Surgery, Head & Neck Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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10
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Florenzano P, Guarda FJ, Jaimovich R, Droppelmann N, González H, Domínguez JM. Radioactive Iodine Administration Is Associated with Persistent Related Symptoms in Patients with Differentiated Thyroid Cancer. Int J Endocrinol 2016; 2016:2586512. [PMID: 27867395 PMCID: PMC5102728 DOI: 10.1155/2016/2586512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Context. Radioiodine (RAI) administration has adverse effects in patients treated for thyroid cancer (DTC), but there is scarce information regarding their intensity and duration. Objective. To evaluate frequency and intensity of early and late RAI-related symptoms in patients with DTC. Design. Observational prospective study. Patients. DTC patients who underwent thyroidectomy, with or without RAI. Measurements. Patients answered 2 surveys: (1) from 0 to 6 months and (2) between 6 and 18 months after initial treatment. Results. 110 patients answered the first survey and 61 both. Nearly 80 percent received RAI. Among early symptoms, periorbital edema, excessive tearing, salivary gland disturbances, dry mouth, taste disorders, and nausea were more frequent and intense among RAI patients. Regarding late symptoms, periorbital edema, salivary gland pain and swelling, and dry mouth were more frequent and intense in RAI patients. Frequency and intensity of adverse effects were not different between low and high RAI doses (50 versus ≥100 mCi). Conclusion. RAI-related symptoms are frequent and usually persist after 6 months of administration, even when low doses are given. This finding must be considered when deciding RAI administration, especially in low risk patients, among whom RAI benefit is controversial.
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Affiliation(s)
- Pablo Florenzano
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco J. Guarda
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Jaimovich
- Department of Nuclear Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán González
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M. Domínguez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- *José M. Domínguez:
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