IoN- Is Ablative Radio-iodine Necessary for Low Risk Differentiated Thyroid Cancer Patients

Exclusion Criteria

• •pT1a - Papillary and Follicular carcinoma which is unifocal and ≤1cm in size, without any positive nodes or unfavourable clinical features, treated by lobectomy.
• •Up to 4cm non-invasive Encapsulated Follicular Variant of Papillary Thyroid Cancer (eFVPTC) with no capsular or vascular invasion (\>4 cm can be included at the discretion of the MDT)
• •non-invasive follicular tumour with papillary-like nuclei (NIFTP)
• •Anaplastic, poorly differentiated or medullary carcinoma
• •R1 or R2 thyroidectomy
• •Patients with:
• •* pN1b
• •* M1
• •Aggressive Papillary thyroid cancer with any of the following features:
• •* Widely invasive
• •* Poorly differentiated
• •* Anaplastic
• •* Tall cell
• •* Columnar cell
• •* Diffuse sclerosing variants
• •Follicular thyroid cancer/Hürthle cell cancer with any of the following features:
• •* Tumours greater than 4cm
• •* Widely invasive
• •* Poorly differentiated
• •* Anaplastic
• •Incomplete resection or lobectomy
• •pT4a and pT4b or macroscopic and microscopic tumour invasion of loco-regional tissues or structures
• •Pregnant women or women who are breast feeding
• •Patients who have had CT performed with iv contrast less than 2-3 months before ablation
• •Previous treatment for thyroid cancer (except surgery in last 6 months)
• •Previous malignancies with limited life expectancy or likely to interfere with the patient's ability to be able to comply with treatment and/or follow-up for at least 5 years
• •The following GI conditions: dysphagia, oesophageal stricture, active gastritis, gastric erosions, peptic ulcer, suspected reduced gastrointestinal motility
• •MDT decision against ablation or suitability for trial in light of severe co-morbid condition/s including:
• •* Unstable angina
• •* Recent myocardial infarction or cerebrovascular accident (CVA)
• •* Severe labile hypertension
• •* Any patient who cannot comply with radiation protection including:
• •* patients with learning difficulties
• •* patients with dementia
• •* patients with a tracheostomy that require nursing care
• •* patients requiring frequent nursing/ medical supervision
• •Eligibility Criteria using TNM8:
• •pT1a - Papillary and Follicular carcinoma which is unifocal and ≤1cm in size, without any positive nodes or unfavourable clinical features, treated by lobectomy.
• •Up to 4cm non-invasive Encapsulated Follicular Variant of Papillary Thyroid Cancer (eFVPTC) with no capsular or vascular invasion (\>4 cm can be included at the discretion of the MDT)
• •non-invasive follicular tumour with papillary-like nuclei (NIFTP)
• •Anaplastic, poorly differentiated or medullary carcinoma
• •R1 or R2 thyroidectomy
• •Patients with:
• •* pN1a with level VII involvement
• •* pN1b
• •* M1
• •Aggressive Papillary thyroid cancer with any of the following features:
• •* Widely invasive
• •* Poorly differentiated
• •* Anaplastic
• •* Tall cell
• •* Columnar cell
• •* Diffuse sclerosing variants
• •Follicular thyroid cancer/Hürthle cell cancer with any of the following features:
• •* Tumours greater than 4cm
• •* Widely invasive
• •* Poorly differentiated
• •* Anaplastic
• •Incomplete resection or lobectomy
• •pT3b, pT4a and pT4b or macroscopic and microscopic tumour invasion of loco-regional tissues or structures
• •Pregnant women or women who are breast feeding
• •Patients who have had CT performed with iv contrast less than 2-3 months before ablation
• •Previous treatment for thyroid cancer (except surgery in last 6 months)
• •Previous malignancies with limited life expectancy or likely to interfere with the patient's ability to be able to comply with treatment and/or follow-up for at least 5 years
• •The following GI conditions: dysphagia, oesophageal stricture, active gastritis, gastric erosions, peptic ulcer, suspected reduced gastrointestinal motility
• •MDT decision against ablation or suitability for trial in light of severe co-morbid condition/s including:
• •* Unstable angina
• •* Recent myocardial infarction or cerebrovascular accident (CVA)
• •* Severe labile hypertension
• •* Any patient who cannot comply with radiation protection including:
• •* patients with learning difficulties
• •* patients with dementia
• •* patients with a tracheostomy that require nursing care
• •* patients requiring frequent nursing/ medical supervision