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OK to stop radioiodine if it produces no significant effect

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BOSTON — Radioactive iodine has been used for more than 50 years as standard treatment for thyroid disease. However, it may not work in all patients. R. Michael Tuttle, MD, discussed when to stop using radioiodine during the American Thyroid Association Frontiers in Thyroid Cancer meeting, held here.

In thyroid cancer, radioiodine, or ¹³¹I, is used after removal of the thyroid and/or during follow-up. The general theory is to stop treatment when additional administered activities are unlikely to produce significant benefit. Several clinical features can be used to determine if additional radioactive iodine treatments are likely to be effective. These include: age, tumor histology, 18 FDG PET scan and whole body radioiodine scans, and most importantly, objective response to previous radioactive iodine treatments, according to Tuttle, who is a member at Memorial Sloan Kettering Cancer Center.

Before stopping treatment, it is essential to make sure all previous attempts were done correctly, said Tuttle, also an associate professor of medicine at Joan and Sanford I. Weill Medical College at Cornell University. This includes making sure that patient did not have CT scans with IV contrast (which contains stable iodine) for several weeks prior to treatment, and that an appropriate low iodine was accompanied by adequate TSH stimulation, he said.

“Just because radioiodine does not work does not mean you have failed,” he said. “There are a lot of tools beyond radioiodine,” including chemotherapy, enrollment in clinical trials and observation. “It is not the end of the road,” he said. – by Katie Kalvaitis

We need to stop giving therapy when it is not working. Throughout history, people have just continued to keep giving radioiodine. It has been the only thing we’ve had to treat thyroid cancer. The idea of stopping ineffective therapy, if you have given a good dose and saw no results in tumor size or number, is that you have failed. Really, it is just a practical message to stop.

– Richard T. Kloos, MD

Secretary, American Thyroid Association

For more information:

• Tuttle RM. When to stop treating with radioiodine. Presented at: American Thyroid Association Frontiers in Thyroid Cancer; July 11-12, 2008; Boston.