Assessing potential impact of 2015 American Thyroid Association guidelines on community standard practice for I-131 treatment of low-risk differentiated thyroid cancer: case study of Jordan.

OBJECTIVES

The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the I activity utilized by an academic tertiary hospital in Jordan.

METHODS

All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and I activity was assigned accordingly. The actual I activity administered was compared with that recommended by the 2015 ATA guidelines.

RESULTS

In total, 135/182 DTC patients (74.2%) managed at JUH underwent I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding I therapy altogether in the 2015 ATA low-risk patients would result in decreasing the I activity in the overall patient population by 37%. Withholding I therapy only in low-risk papillary thyroid microcarcinomas while administering 1.11 GBq of I to other low-risk patients would result in 28% reduction of I.

CONCLUSION

This study demonstrates a significant reduction in I therapeutic activity that would be given to DTC patients in an academic tertiary setting in Jordan, following acceptance of the 2015 ATA recommendations. Institutions that adopted the 2015 ATA guidance should measure outcomes in comparison to their historical controls and report those findings, while long-term results of randomized controlled trials are forthcoming.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.