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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer

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Published on: June 9, 2023

RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system.

Rebecca Zeuren¹, Agnese Biagini¹, Ravinder K Grewal²

¹Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.

The Laryngoscope

|April 21, 2015

Summary

Highly sensitive imaging detects microscopic radioactive iodine (RAI) uptake in most patients after total thyroidectomy for differentiated thyroid cancer (DTC). These common residual foci do not correlate with thyroglobulin levels, suggesting radical removal may not be necessary.

Keywords:

RRA postoperative Tg radioactive iodine remnant ablation thyroid cancer thyroidectomy

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Area of Science:

Endocrinology
Nuclear Medicine
Oncology

Background:

Selective radioactive iodine (RAI) use necessitates reevaluation of complete thyroidectomy importance.
Improved localization via post-RAI remnant ablation SPECT/CT aids in assessing residual thyroid tissue.

Purpose of the Study:

To define anatomic sites of residual RAI uptake post-thyroidectomy using SPECT/CT.
To establish a novel classification system for RAI uptake related to thyroid anatomy and neural structures.

Main Methods:

Retrospective analysis of 141 differentiated thyroid cancer (DTC) patients.
Localization of RAI uptake foci in the thyroid bed using SPECT/CT during RAI remnant ablation.

Main Results:

99% of patients showed RAI uptake foci on SPECT/CT, with common sites including Berry's ligament and superior thyroid poles.
Despite residual foci, 53% had non-stimulated thyroglobulin (Tg) <0.6 ng/mL.
Discrete RAI uptake foci were identified in various thyroid bed locations.

Conclusions:

Microscopic RAI-avid foci are common after total thyroidectomy for DTC.
A classification system for these foci (neural-related and capsule-related) was proposed.
The presence of these foci does not appear to impact postoperative Tg levels, questioning the need for aggressive removal.