To Treat or Not to Treat: The Role of Adjuvant Radioiodine Therapy in Thyroid Cancer Patients
Table 1
Indications for RAI (adapted from NCCN 2012 guidelines).
Recommended
(i) All patients with gross extrathyroidal extension, primary tumor size > 4 cm, distant metastases
Papillary Follicular Hurthle
(ii) For select patients without gross residual disease when the combination of clinical factors predicts an intermediate to-high-risk for recurrence or disease-specific mortality (e.g., primary tumors ranging from 1–4 cm confined to the thyroid, high-risk histologies, vascular invasion, or cervical lymph node metastases)
Papillary
Not recommended
(i) Not routinely recommended for patients with either unifocal or multifocal papillary microcarcinomas (<1 cm) confined to the thyroid
Papillary
(ii) Not required: minimally invasive follicular thyroid carcinoma or Hurthle cell carcinoma confined to the thyroid when the primary tumor is small and demonstrates only invasion of the tumor capsule without vascular invasion
