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Surg Oncol. 2019 Jun;29:184-189. doi: 10.1016/j.suronc.2019.05.011. Epub 2019 May 21.

The overuse of radioactive iodine in low-risk papillary thyroid cancer patients.

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Temple University Hospital, Department of Surgery, 3401 N Broad St, Philadelphia, PA, 19140, United States.
Lewis Katz School of Medicine at Temple University, Department of Clinical Sciences, 3500 N Broad St, Philadelphia, PA, 19140, United States.
Thomas Jefferson University, Department of Surgery, Thyroid and Parathyroid Surgery Program, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, United States. Electronic address:



The aim of this study was to use current American Thyroid Association (ATA) management guidelines to identify groups who might be at risk of overtreatment with radioactive iodine (RAI) ablation after surgery for low-risk papillary thyroid cancer (PTC).


PTC patients were identified using the Surveillance, Epidemiology and End Results database. Characteristics of low-risk patients (defined as T1 without metastasis) were compared to those not low-risk. Predictors of receiving RAI for low-risk disease were determined using logistic regression.


Of 32,229 cases, 17,286 (53.6%) were low-risk. Low-risk patients, compared to others, were older (mean age 51.3 versus 48.5 years), and more often female (81.6% versus 71.7%), white (69.7% versus 62.0%), and insured (87.6% versus 85.6%)(all p-values < 0.001). Nearly 25% of low-risk patients received RAI. Predictors of overtreatment with RAI included age <45 years (OR: 1.393; 95% CI: 1.250-1.552), age 45-64 years (OR: 1.275; 95% CI: 1.152-1.412), male sex (OR: 1.191; 95% CI: 1.086-1.305), Hispanic (OR: 1.236; 95% CI: 1.110-1.376) and Asian (OR: 1.306; 95% CI: 1.159-1.473) race, and extensive lymphadenectomy (OR: 1.243; 95% CI: 1.119-1.381).


Low-risk PTC patients were more likely to receive post-surgical RAI when not indicated under ATA guidelines if they were younger, male, Hispanic or Asian, or underwent extensive lymph node surgery. Identification of groups at risk for overtreatment can help impact practice patterns and improve the effective utilization of healthcare resources.


Overtreatment; Radioactive iodine; Thyroid cancer

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