The optimal management for differentiated thyroid cancer (DTC) patients with an indeterminate response (IDR) to initial radioactive iodine(RAI) therapy remains a clinical dilemma. This study aimed to compare outcomes between active surveillance and RAI retreatment in IDR patients and to identify predictors of persistent non-excellent response (NER). This retrospective cohort study included 136 DTC patients classified as IDR 6 months after initial RAI therapy. Patients were categorized into a Retreatment Group (n = 18), who received additional RAI treatment, and a Follow-up Group (n = 118), managed with active surveillance. Treatment response was assessed during follow-up. The rate of excellent response (ER) was significantly higher in the Follow-up Group compared to the Retreatment Group (58.47% vs. 33.33%, P = 0.046). In the Follow-up Group, multivariate analysis identified older age (≥ 45.50 years; OR, 1.07; P < 0.001), lateral cervical lymph node metastasis (N1b; OR, 2.92; P = 0.016), and higher stimulated thyroglobulin (sTg) level at first follow-up (≥ 2.025 ng/mL; OR, 1.31; P < 0.001) as independent predictors of NER. A nomogram incorporating these three factors demonstrated good predictive accuracy, with an area under the curve (AUC) of 0.752, which was confirmed by internal validation (AUC = 0.752). For DTC patients with an IDR, active surveillance was associated with a higher rate of ER compared to immediate RAI retreatment. A nomogram based on age, N1b status, and sTg level can effectively stratify the risk of NER, potentially guiding more individualized management decisions for this patient population.
Miao et al. (Tue,) studied this question.
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