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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

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Combined Otolaryngology Spring Meeting
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SO-CALLED TOTAL THYROIDECTOMY: MEASURING THE EXTENT OF THYROID SURGERY WITH RAI

Presentation: S003
Topic: Clinical - Thyroid / Parathyroid
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 10:30 AM - 11:30 AM Discussions
Authors: Juntian Lang, MD, , PhD, Uma Ramaswamy, Eric Rohren, MD, Naifa L Bussaidy, MD, Maria E Cabanillas, MD, Randal S Weber, MD, FACS, Christopher F Holsinger, MD, FACS
Institution(s): The University of Texas MD Anderson Cancer Center

Objective
To investigate the rate of patients with or without thyroid remnant and the relationship between postoperative stimulated thyroglobulin(Tg) level and thyroid remnants after total thyroidectomy for patients with differentiated thyroid carcinoma.

Patients and Methods
We evaluated patients undergoing total thyroidectomy at MD Anderson Cancer Center from 01/01/2001 to 02/20/2012 for T1-3N0M0 differentiated thyroid cancer (DTC) who received diagnostic post-operative radioactive iodine imaging. Two hundred and twenty-nine patients had quantitated uptake on RAI imaging and were included in this study. Based on the calculation of I123 background signal, radioactive iodine uptake of 0.2% was taken as the cut-off of presence or absence of thyroid remnant. Average time to last follow-up was 45.2 months.

Results
Ninty-three patients (40.6%) with uptake of radioactive iodine less than 0.2% on post-operative imaging suggesting that a total thyroidectomy was performed. The remaining 136 patients demonstrated some measurable iodine-avid thyroid tissue and/or tumor in the thyroid bed (112; 82.4%), the neck (6; 4.4%) or both (17, 12.5%). For those patients with positive iodine signal, the average 24-hour iodine uptake was 1.1% (0.2-7.0%). For the entire study population (229 pts), average 24-hour iodine uptake was 0.67%. Measurable Tg (≥1ng/ml) was found in 19/93 (20.4%) patients without thyroid remnant and in 82/136 (60.3%) (x2=38.5, p=0.000) with thyroid remnant. There were five recurrences (2%), three of which were RAIU positive, and two patients showed no postoperative thyroid remnant. One patient with RAI proven thyroid remnant died of disease.

Conclusion
One hundred and thirty-six of 229(59.4%) DTC patients had residual thyroid tissue after total thyroidectomy. The rate of detectable Tg in thyroid remnant positive group is higher than that of thyroid remnant negative group (60.3% vs. 20.4%, p=0.000).

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