Evidence map›Paper›PMID 40182183›Full record

ArticleJournal of the Endocrine Society2025

Radioactive Iodine in Differentiated Thyroid Cancer: Effect on Detection of Distant Metastases Comparing 4 Guidelines.

Merel T Stegenga, W Edward Visser, Robin P Peeters, Folkert J van Kemenade, Marco Medici, Tessa M van Ginhoven, Frederik A Verburg, Evert F S van Velsen

Abstract read
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In one paragraph

Article in Journal of the Endocrine Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Merel T StegengaAcademic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0009-0008-1096-8564
W Edward VisserAcademic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-5248-863X
Robin P PeetersAcademic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0001-7732-9371
Folkert J van KemenadeAcademic Center for Thyroid Disease, Department of Pathology, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-4225-4354
Marco MediciAcademic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-7271-7858
Tessa M van GinhovenAcademic Center for Thyroid Disease, Department of Surgery, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-9365-4892
Frederik A VerburgAcademic Center for Thyroid Disease, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.
Evert F S van VelsenAcademic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-6938-065X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Context: Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases. Objective: This study compares 4 guidelines on RAI indications and potentially missed metastases. Methods: DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines. Results: In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%). Conclusion: Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.

Indexed as

differentiated thyroid cancerdistant metastasesradioiodine therapy

Identifiers

PMID40182183
PMCPMC11966102

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.