ABSTRACT
Objective: The treatment of patients with differentiated thyroid cancer (DTC) was modified in the
last decade towards a more individualized approach according to the risk of recurrence (RR). We
compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or
did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk.
Materials and methods: We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All
patients were reclassified according to the dynamic risk stratification (low or high). Patients with
high dynamic risk received RRA (141 patients).
Results: LRR patients who received RRA presented
a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to
2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR
of 22%, compared to 5% in patients without RRA (p=0.008). Conclusions: This study demonstrates
the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The
lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights
the adequate selection of those who would not benefit from RRA, even with an intermediate risk of
recurrence.
Keywords
Thyroid cancer; dynamic risk; without remnant ablation; structural incomplete response
