From the Guidelines
Total body scintigraphy (TBS) is not indicated for patients with low-risk status. For low-risk patients, the use of radioiodine scanning is usually unnecessary as these patients have excellent prognosis with very low recurrence rates 1. Instead, follow-up for low-risk patients typically consists of periodic neck ultrasounds and serum thyroglobulin measurements, which provide sufficient surveillance.
Key Points
- The European Society for Medical Oncology (ESMO) guidelines recommend against radioiodine ablation in very low-risk patients, which implies that TBS is also not necessary in these cases 1.
- The guidelines suggest that radioiodine ablation is recommended in high-risk patients and in low-risk patients, but there is no indication in very low-risk patients 1.
- Effective thyroid ablation requires adequate stimulation by TSH, and the method of choice for preparation to perform a radioiodine scan is based on the administration of recombinant human TSH (rhTSH) while the patient is on levo-thyroxine (LT4) therapy 1.
- TBS exposes patients to radiation and may lead to unnecessary treatments without improving outcomes in this population.
- However, if there are specific concerns about possible metastatic disease or unusual pathological features, individual risk assessment by an endocrinologist may occasionally warrant scanning even in otherwise low-risk patients.
From the Research
Total Body Scintigraphy Indication
- Total body scintigraphy (TBS) is a diagnostic tool used to detect thyroid remnants or recurrent disease in patients with differentiated thyroid cancer.
- The indication for TBS in patients with low risk status is a topic of discussion, with some studies suggesting that it may not be necessary in certain cases.
Studies on Low-Risk Patients
- A study published in 2006 2 found that whole-body scintigraphy (WBS) was not useful in the initial follow-up of patients with papillary thyroid microcarcinoma (PTMC) without risk factors and anti-Tg antibodies who did not undergo radioiodine treatment.
- Another study published in 2011 3 found that a second routine diagnostic WBS 1 year after thyroablation is not indicated in low-risk patients, as 95.8% of these patients had no residual disease.
- A procedure guideline published in 2007 4 states that follow-up without (131)I WBS is only justified if certain preconditions are fulfilled, including low-risk group pT1-2, pN0 M0, and stimulated thyroglobulin (Tg)-level <2 ng/mL.
Alternative Diagnostic Tools
- Neck ultrasonography (US) has been shown to be a useful method in the evaluation of thyroid nodules, with high sensitivity and specificity in detecting node metastases 2, 5.
- Serum thyroglobulin measurements are also an important tool in the follow-up of patients with differentiated thyroid cancer, with abnormal levels indicating potential metastases or local recurrences 6.
Conclusion Not Applicable
References Not Applicable
Instead, the information provided suggests that total body scintigraphy may not be indicated for patients with low risk status, and alternative diagnostic tools such as neck ultrasonography and serum thyroglobulin measurements may be more appropriate. However, the decision to use TBS should be made on a case-by-case basis, taking into account the individual patient's risk profile and clinical characteristics, as supported by studies 2, 3, 4.