Nuclear imaging expert debates ablation therapy for thyroid cancer

A medical expert at the Weill Cornell Medical College recently published an article weighing the pros and cons of using radioactive iodine ablation after partial or total thyroidectomies.

Stanley Goldsmith, director of the school's Department of Nuclear Medicine and Molecular Imaging, wrote in the journal Seminars in Nuclear Medicine that an individual approach should be taken when using the treatment, since different patients often have radically different symptoms.

In particular, Goldsmith said that low-risk patients - those who do not have an advanced form of thyroid cancer - may not require post-operative ablation at all, or only in low doses at most. That being said, he added that defining "low risk" can be problematic.

Ablation with radioactive iodine involves taking one or a series of pills containing iodine-131, a radioactive isotope of the element. Since thyroid cells naturally absorb iodine that circulates through the body, cancerous thyroid cells - and in fact any of the gland's cells at all - that remain after a thyroidectomy have a high possibility of absorbing the isotope and being destroyed.

The Mayo Clinic reports that radioactive iodine therapy can be used to prevent recurrence of thyroid cancer, as well as to treat the disease when it has spread outside the gland and into the body.

In his article, Goldsmith noted that this form of therapy can have negative side effects. These can include swollen glands, dry mouth, fatigue and a drop in blood count, according to the Thyroid Cancer Survivors' Association.

In light of the varying degrees of thyroid cancer, Goldsmith recommended that patients with a low-risk form of the disease receive much lower doses of the radioactive treatment. Though he explored the possible benchmarks by which "low risk" can be defined, he concluded that the term ultimately evades definition, since even the smallest detectable thyroid tumor poses some risk to the patient.

He determined that diagnosticians should remain informed and use their best judgment in each individual case, rather than trying to create overarching guidelines for ablation.
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