ArticleBMC cancer2026
Comparative outcomes of retreatment vs follow-up in DTC patients with intermediate response following initial radioactive iodine therapy: a retrospective cohort study.
Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe optimal management for differentiated thyroid cancer (DTC) patients with an indeterminate response (IDR) to initial radioactive iodine(RAI) therapy remains a clinical dilemma. This study aimed to compare outcomes between active surveillance and RAI retreatment in IDR patients and to identify predictors of persistent non-excellent response (NER).
methodsThis retrospective cohort study included 136 DTC patients classified as IDR 6 months after initial RAI therapy. Patients were categorized into a Retreatment Group (n = 18), who received additional RAI treatment, and a Follow-up Group (n = 118), managed with active surveillance. Treatment response was assessed during follow-up.
resultsThe rate of excellent response (ER) was significantly higher in the Follow-up Group compared to the Retreatment Group (58.47% vs. 33.33%, P = 0.046). In the Follow-up Group, multivariate analysis identified older age (≥ 45.50 years; OR, 1.07; P < 0.001), lateral cervical lymph node metastasis (N1b; OR, 2.92; P = 0.016), and higher stimulated thyroglobulin (sTg) level at first follow-up (≥ 2.025 ng/mL; OR, 1.31; P < 0.001) as independent predictors of NER. A nomogram incorporating these three factors demonstrated good predictive accuracy, with an area under the curve (AUC) of 0.752, which was confirmed by internal validation (AUC = 0.752).
conclusionFor DTC patients with an IDR, active surveillance was associated with a higher rate of ER compared to immediate RAI retreatment. A nomogram based on age, N1b status, and sTg level can effectively stratify the risk of NER, potentially guiding more individualized management decisions for this patient population.
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