RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system

Objective Recent, more selective use of radioactive iodine (RAI) has led to reevaluation of the clinical importance of achieving complete total thyroidectomy with minimal residual normal thyroid tissue. We utilize the improved localization by post‐RAI remnant ablation, single photon emission compute...

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Bibliographic Details
Published in:The Laryngoscope 2015-10, Vol.125 (10), p.2417-2424
Main Authors: Zeuren, Rebecca, Biagini, Agnese, Grewal, Ravinder K., Randolph, Gregory W., Kamani, Dipti, Sabra, Mona M., Shaha, Ashok R., Tuttle, R. Michael
Format: Article
Language:English
Subjects:
Ablation Techniques
Adult
Female
Humans
Iodine
Iodine Radioisotopes - therapeutic use
Male
Medical imaging
Middle Aged
Postoperative Period
postoperative Tg
radioactive iodine
remnant ablation
RRA
thyroid cancer
Thyroid Gland - diagnostic imaging
Thyroid Gland - pathology
Thyroid Neoplasms - pathology
Thyroid Neoplasms - radiotherapy
Thyroid Neoplasms - surgery
Thyroidectomy
Tomography
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Women
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Summary:Objective Recent, more selective use of radioactive iodine (RAI) has led to reevaluation of the clinical importance of achieving complete total thyroidectomy with minimal residual normal thyroid tissue. We utilize the improved localization by post‐RAI remnant ablation, single photon emission computerized tomography‐computed tomography (SPECT‐CT) to define specific anatomic sites of residual RAI‐uptake foci after total thyroidectomy for differentiated thyroid cancer (DTC) and to provide a novel classification system relating uptake to thyroid anatomy and preservation of adjacent neural structures. Study Design Retrospective. Method Radioactive iodine‐uptake foci in thyroid bed were localized by SPECT/CT imaging at the time of RAI remnant ablation in 141 DTC patients undergoing total thyroidectomy. Results Minimal residual RAI uptake (median 0.32% at 24 hours) in the thyroid bed was detected by diagnostic planar whole body scans in 93% and by posttherapy SPECT/CT imaging in 99% of subjects. Discrete RAI uptake foci were identified on the SPECT/CT imaging at Berry's ligament (87%), at superior thyroid poles (79%), in paratracheal‐lobar regions (67%), in isthmus‐region (54%), and in pyramidal lobe (46%). Despite the residual foci, the nonstimulated thyroglobulin (Tg) prior to remnant ablation (with a median thyroid‐stimulating hormone of 0.36 m IU/L) was 
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.25295