Use of RAI for Thyroid Cancer Comes Under Scrutiny

Doctors may be increasingly using radioactive iodine inappropriately to treat early stage, low-risk thyroid cancer after surgery, contrary to the latest guidelines and with some evidence it will do more harm than good, according to a report from the University of Michigan.

Conversely, the study indicates that some patients with more clinically significant, higher-risk disease are not getting treated with radioactive iodine according to guidelines.

"Our study findings indicate there's variation in care, and that's suggestive that there is some provider uncertainty in regard to which patients actually need radioactive iodine," Haymart said in a phone interview.

"For certain groups, radioactive iodine treatments are clearly beneficial, but for other groups, the patients are going to do well no matter what you do in regard to treatment, so the risk of using radioactive iodine really needs to be considered," said Megan R. Haymart, MD, author of the study.

"The recent guidelines (issued in 2009 by the American Thyroid Association) say those with very low risk disease don't need it, but there's a huge middle ground – a gray zone – where they leave it to the provider's discretion. So it's very possible that some of those patients don't need it as well."