Feasibility of low doses of I-131 for thyroid ablation in postsurgical patients with thyroid carcinoma

The feasibility of using low doses of I-131 (30 mCi) for ablation of thyroid remnants following surgery for papillary and follicular thyroid carcinoma was examined in 21 patients. Six weeks following near-total thyroidectomy and three days following intramuscular thyroid-stimulating hormone (10 IU), patients were given 30 mCi of I-131 and scans were performed 24 to 72 hours later. Remaining thyroid tissue was identifiable in the thyroid bed in 19 patients, and two patients also had evidence of cervical metastases. Patients with metastases received an additional 100 mCi of I-131. Follow-up I-131 scans were performed at nine to 15-month intervals in ten patients who initially received 30 mCi of I-131, and only one patient showed complete ablation of the residual thyroid tissue, whereas the remaining nine patients had persistent uptake of I-131 in the same regions in which the uptake was seen in the initial postoperative scans. One of the nine patients had evidence of a cervical metastasis as well. It is therefore apparent that total or near-total thyroidectomy rarely removes all thyroid tissue and that an "out-patient" dose of I-131 is not adequate for ablation of postoperative thyroid remnants.