Intermediate risk thyroid cancer management: physician survey

Context Variability exists in use of radioactive iodine (RAI) treatment in intermediate risk (IR) thyroid cancer. Objective The study surveyed clinicians about their use of RAI in theoretical cases of patients with IR thyroid cancer. Design A survey presented patient cases with pathology results and two variations consisting of baseline thyroglobulin levels of ≤5 ng/mL and >5 ng/mL. Respondents were queried as to their use of RAI therapy in each case. Univariate Bayesian cumulative ordinal regression models were used to evaluate the relationships between selected predictors and the response. Setting Online survey Participants American Thyroid Association members Intervention Participants responded regarding their management of 15 patient cases of IR thyroid cancer. Main outcome measures Use of RAI therapy, consisting of no RAI or doses of approximately 30 mCi, 40-74 mCi, 75-100 mCi, or more than 100 mCi. Results Members were surveyed in May and June, 2024. Using matched vignettes, respondents were more likely to recommend RAI doses of ≥30 mCi and more likely to recommend higher RAI doses in general when thyroglobulin levels were >5 ng/mL compared to ≤5 ng/mL (ORs 2.89-18.28). Examining unadjusted associations within the case scenarios presented, the presence of lymph nodes measuring 0.2–3 cm, more than five positive lymph nodes, and lateral lymph nodes were associated with higher RAI dose recommendations (unadjusted ORs 2.33-26.16). Conclusion Within the IR category, there were specific pathology and biochemical findings associated with greater likelihood of the clinician recommending RAI therapy. These findings may be instructive in understanding how these features are perceived to add to the risk of thyroid cancer recurrence.