The use of radioactive iodine (RAI) after total thyroidectomy for patients at the American Thyroid Association (ATA) who are at intermediate risk of recurrence is controversial. This is due to the lack of prospective randomized trials proving a benefit to recurrence or survival of RAI therapy in this group. In the absence of such evidence, clinicians struggle to recommend for or against this therapeutic approach which frequently results in overtreatment. This review describes key elements in the decision-making process that help clinicians more comprehensively evaluate the need for RAI therapy in patients with thyroid cancer at intermediate risk of recurrence. A clear definition of the purpose of RAI therapy should be conveyed to patients. In this sense, adjuvant RAI therapy intends to decrease recurrence, and ablation therapy is used to facilitate surveillance. Better stratification of the intermediate risk category into a low–intermediate subgroup and an intermediate–high-risk subgroup results in less heterogeneity and a more precise prediction of recurrence risk. The evaluation of post-operative thyroglobulin levels may prevent the overtreatment of low–intermediate-risk patients when their thyroglobulin level is <2.5 ng/mL. the integration of tumor genomics (when available) alongside pathologic features can enhance the ability of the clinician to predict iodine concentration in thyroid cancer cells. Finally, a detailed consideration of the adverse effects of RAI, patients’ comorbidities, and patient preferences will result in a patient-centered personalized approach. Systematic examination of these variables will ultimately provide a framework for making more educated decisions on the use of RAI in patients at intermediate risk of recurrence that will prevent overtreatment and minimize harm.
对于美国甲状腺协会（ATA）复发风险中危患者，在全甲状腺切除术后是否使用放射性碘（RAI）治疗存在争议。这是由于缺乏前瞻性随机试验证明RAI治疗对该人群的复发率或生存率具有明确获益。在缺乏此类证据的情况下，临床医生难以明确推荐或反对该治疗方案，这常导致过度治疗。本综述阐述了决策过程中的关键要素，以帮助临床医生更全面地评估中危复发风险甲状腺癌患者对RAI治疗的需求。应向患者明确传达RAI治疗的目的：辅助性RAI治疗旨在降低复发风险，而清灶治疗则用于辅助监测。将中危类别进一步细分为中低危亚组和中高危亚组，可减少组间异质性并更精准预测复发风险。术后甲状腺球蛋白水平评估（当<2.5 ng/mL时）可避免对中低危患者进行过度治疗。将肿瘤基因组学（若可行）与病理特征相结合，可提升临床医生预测甲状腺癌细胞摄碘能力。最后，综合考虑RAI的不良反应、患者合并症及个人偏好，将形成以患者为中心的个体化治疗方案。系统评估这些变量最终将为中危复发风险患者的RAI使用决策提供框架，从而避免过度治疗并最大限度减少损害。
肿瘤(癌症)患者之家