I-131 therapy for thyroglobulin positive patients without anatomical evidence of persistent disease.

OBJECTIVE: the aim of this retrospective study was to evaluate the diagnostic relevance of I-131 whole body scan (WBS) performed after second empirical therapeutic doses of iodine-131 (I-131) in thyroglobulin (Tg)-positive thyroid cancer patients without evidence of local and distant metastasis. We also evaluated the efficacy of second empirical therapeutic doses of I-131 in these patients.
METHODS: we retrospectively compared the results of diagnostic I-131 WBS and post-therapy scans of second therapeutic doses of I-131 in 38 patients with detectable Tg while off T4 therapy (TSH>25 mlU/ml). All patients underwent a near-total or total thyroidectomy and I-131 ablation with 75-125 mCi. All of the reported subjects had no prior evidence for detectable disease before second high dose empirical I-131 therapy.
RESULTS: there was almost complete concordance in uptake between diagnostic I-131 WBS and final scans carried out after second I-131 therapy in 22 out of 38 patients. Whereas abnormal foci of new uptake was detected in all of the remaining 16 patients, seven of them were found to have negative diagnostic WBS results. Distant metastases were observed in 3 of 16 subjects and mediastinal uptake was found in 2 of 16 patients in post-therapy scan. During the subsequent follow-up, extending from 8-46 months, 6 out of 16 patients showed normalization of serum Tg levels while off T4. Serum Tg levels were normalized in 3 out of 7 patients who had negative WBS results, increased in one and unchanged in the remaining 3. None of the patients with distant metastases had normalization of Tg levels. Totally, 6 out of 38 showed normalization of Tg levels while off T4 therapy.
CONCLUSION: the empirical therapeutic doses of 1-131 may help in localization of the disease in Tg positive patients without anatomical evidence of persistent disease, but the effect of I-131 therapy on long-term survival is not obvious.