Nosheen Fatima, Maseeh uz Zaman, Areeba Zaman, Nadeem Ahmad, Rabia Tahseen, Sidra Zaman, Unaiza Zaman



The American Thyroid Association (ATA) 2015 guidelines favor lobectomy for tumors 1-4 cm, recommend use of contrast enhanced CT/MRI examination for high risk patients and low or no radioiodine-131 therapy for low to intermediate risk patients. However, these guidelines have been declined by European Association of Nuclear Medicine (EANM) on a plea that these are based on conflicting weak retrospective studies and skewed interpretation of existing database. Lack of valid prospective randomized clinical trials due to tumor biology and exceedingly low event rate which need longer follow-up is the primary reason for these controversies. Currently three prospective randomized clinical trials upon low risk DTC patients are underway and hopefully their results would clarify dense smokescreen to a greater extent in years to come.


Key Words: Differentiated thyroid cancer; lobectomy; thyroidectomy; iodinated contrast; radioiodine-131 treatment; prospective trials


Full Text:



. Daniel A. Pryma . Controversies on the Use of Radioiodine in Thyroid Cancer: We Need More and Better Data. J Nucl Med 2018; 59 (8): 1184-7

. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BG, et al. British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014;81(suppl 1):1–122.

. Tuttle R M. Controversial Issues in Thyroid Cancer Management. J Nucl Med 2018; 59:1187–1194

. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26: 1–133.

. Schmidt M, G¨orges R, Drzezga A, Dietlein M. A Matter of Controversy: Is Radioiodine Therapy Favorable in Differentiated Thyroid Carcinoma? J Nucl Med 2018; 59:1195–1201

. Verburg FA, Aktolun C, Chiti A, Frangos S, Giovanella L, Hoffmann M, et al.; EANM and the EANM Thyroid Committee. Why the European Association of Nuclear Medicine has declined to endorse the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:1001–05.

. Calcatera NA, Lutfi W, Suman P. Concordance of preoperative clinical stage with pathological stage in patients #45 years with well-differentiated thyroid cancer. Endocr Pract. 2018;16:27–32

. Duh QY, Shen WT. Clinical implications of postoperative up-staging of differentiated

thyroid cancer based upon pathologic evaluation. Endocr Pract. 2018; 16:124–25.

. Padovani RP, Kasamatsu TS, Nakabashi CC, Camacho CP, Andreoni DM, Malouf EZ, et al. One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy. Thyroid. 2012;22:926–30

. Higashi T, Nishii R, Yamada S, Nakamoto Y, Ishizu K, Kawase S, et al. Delayed Initial Radioactive Iodine Therapy Resulted in Poor Survival in Patients with Metastatic Differentiated Thyroid Carcinoma: A Retrospective Statistical Analysis of 198 Cases. J Nucl Med 2011; 52:683–89

. Haugen BR. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed? Cancer 2017;123:372–81.

. Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260: 601–05

. Chow SM, Yau S, Kwan CK, Patricia C M Poon, Stephen C K Law. et al. Local and regional control in patients with PTC: specific indications of external radiotherapy and radioactive iodine. Endocr Relat Cancer. 2006;13:1159–72

. Adam MA, Pura J, Goffredo P, Dinan MA, Reed SD, Scheri RP, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol. 2015;33:2370–75.

. Orosco RK, Hussain T, Brumund KT, Oh DK, Chang DC, Bouvet M. Analysis of age and disease status as predictors of thyroid cancer-specific mortality using the Surveillance, Epidemiology, and End Results database. Thyroid. 2015;25:125–32.

. Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab. 2015;100:1529–36.

. Mehanna H, Al-Maqbili T, Carter B, Martin E, Campain N, Watkinson J, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21329 person-years of follow-up. J Clin Endocrinol Metab. 2014;99:2834–43.

. Rubino C, de Vathaire F, Dottorini ME, Hall P, Schvartz C, Couette JE, et al. Second primary malignancy in thyroid cancer patients. Br J Cancer. 2003;89:1638–44.

. Hirsch D, Shohat T, Gorshtein A. Incidence of nonthyroidal primary malignancy and the association with 131I treatment in patients with differentiated thyroid cancer. Thyroid. 2016;26:1110–16.

. Seo GH, Cho YY, Chung JH, Kim SW. Increased risk of leukemia after radioactive iodine therapy in patients with thyroid cancer: a nationwide, population-based study in Korea. Thyroid. 2015;25:927–34.

. Sawka AM, Brierley JD, Tsang RW, Thabane L, Rotstein L, Gafni A, et al. An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer. Endocrinol Metab Clin North Am. 2008;37: 457–80.

. Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, et al American Thyroid Association Surgical Affairs Committee. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.


  • There are currently no refbacks.

© Copyright PJR 2008-