Cancers de la thyroïde et traitement par iode 131

Initial treatment of differentiated thyroid cancer is based on a total thyroidectomy and in many cases on the administration of radioactive iodine. Following total thyroidectomy, radioactive iodine is given, based on the primary tumor characteristics. In case of a very low-risk of recurrence it is recommended not to give radioactive treatment. In case of intermediate risk patients, two randomized prospective studies (ESTIMABL and HILO) have shown that an activity of 1.1. GBq (30. mCi) given after recombinant human thyroid stimulating hormon (rhTSH) was adequate. A further step is taken towards less treatment has now been undertaken with the ESTIMABL2 study, a prospective randomized study comparing a treatment with 1.1. GBq (30. mCi) of radioactive iodine treatment to follow-up without ablation. In case of high-risk patients or in case of persistent disease a high activity of radioactive iodine is given after TSH stimulation. In case of distant metastases, cure is obtained with radioactive iodine in 1/3 of the patients. In the absence of cure, patients are classified as refratory to radioactive iodine and may benefit from tyrosine kinase inhibitors.