Radioiodine remnant ablation in low-risk differentiated thyroid cancer: the “con” point of view

A growing body of evidence is challenging the indiscriminate use of postoperative radioiodine for remnant ablation (RRA) in low-risk (LR) differentiated thyroid cancer patients. We critically reviewed the current evidence on which the rationale for RRA is based for LR patients and analyzed the new evidence-based recommendations for LR patients from the draft of the 2015 American Thyroid Association (ATA) guidelines. Cost-effective tools for staging and follow-up, such as neck ultrasonography and serial thyroglobulin testing, are useful for monitoring non-RRA-treated patients. Recurrence rates are very low in non-RRA-treated LR patient cohorts. Most RRA side effects are mild and transient, but can impair a patient's quality of life. RRA is appropriately not routinely recommended in LR patients according to the draft 2015 ATA guidelines and should be reserved for higher-risk patients.