Intermediate-Risk Papillary Thyroid Cancer: Not Everyone Needs Radioactive Iodine

Area of Science:

• Endocrinology
• Oncology
• Surgical Oncology

Background:

• Intermediate-risk papillary thyroid carcinoma (PTC) represents a significant portion of diagnoses but has variable recurrence risks.
• The efficacy of postoperative radioactive iodine (RAI) in these patients remains unclear, necessitating further investigation into treatment strategies.

Purpose of the Study:

• To evaluate the outcomes of patients with intermediate-risk PTC managed without adjuvant RAI.
• To describe patient characteristics, response to therapy, and risk stratification using both ATA 2015 and ATA 2025 criteria.

Main Methods:

• A retrospective cohort study included 99 adult patients with ATA 2015 intermediate-risk PTC who underwent total thyroidectomy or thyroid lobectomy.
• Omission of RAI was guided by postoperative histopathology, ultrasound, thyroglobulin, and anti-thyroglobulin antibody levels.
• Response to therapy was assessed using ATA 2015 dynamic risk stratification and reassessed with ATA 2025 criteria.

Main Results:

• The study included 99 patients (84.8% women, mean age 40.2 years) with a median follow-up of 4.8 years.
• Features included microscopic extrathyroidal extension (51.5%) and lymph node metastases (37.4%).
• No incomplete responses or structural recurrences were observed; ATA 2025 reclassified risk for 94.9% of patients.

Conclusions:

• Selected intermediate-risk PTC patients can be managed without adjuvant RAI, achieving excellent mid-term outcomes.
• This approach supports a risk-adapted de-escalation strategy in PTC management.
• Further research can refine criteria for omitting RAI in intermediate-risk PTC.