Thyroid Diseases

Radioactive iodine - is it OK not to have it

03/05/2008 10:38PM

Question:

I have multifocal thyroid cancer (follicular variant of papillary carcinoma). The maximum tumor size was 1.2 cm on the right lobe, and the largest tumor on the left lobe was also 1.2 cm. The tumors were throughout the entire thyroid though and the isthmus - the other ones were just smaller than 1.2 cm. I had a total thyroidectomy two months ago, and am waiting to see the oncologist. I am in my early 40`s and female - so those are two points in my favor. Apparently some oncologists do not do radioactive iodine if the tumors are < 4 cm - others have different cutoffs of < 1 cm or < 1.5 cm. If the oncologist thinks my tumors are too small to do the radioactive iodine, how else can I be followed up? Thyroglobulin testing wouldn`t work, right? I`m really worried about the cancer recurring. Do they just do ultrasounds to follow you then?
Many thanks for your advice.

Answer:

You are right that several of the characteristics of your tumor are favorable but I would still recommend you consult with the oncologist but maybe more importantly, a nuclear medicine doc who treats thyroid cancer with radioactive iodine. The side effects are usually minor as the radiation is focused mostly in the sites of iodine uptake which is any residual thyroid and any tumor cells. This will make surveillance easier with low dose scans and Thyroglobulin testing.

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Response by:

Jeffrey J. Sussman, MD
Assistant Professor of Surgery
Division of Surgical Oncology
Department of Surgery
College of Medicine
University of Cincinnati