Surgery with or without postoperative RAI therapy

Surgery with or without 131I ablation can be useful in controlling local recurrences, regional node metastases, or occasionally, metastases at other localized sites.[33] Approximately 50% of the patients who undergo surgery for recurrent tumors can be rendered free of disease with a second operation.[30] Local and regional recurrences detected by 131I scan and not clinically apparent can be treated with 131I ablation and have an excellent prognosis.[34]

Up to 25% of recurrences and metastases from well-differentiated thyroid cancer may not show 131I uptake. For these patients, other standard imaging techniques such as ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography scans may detect recurrent or metastatic disease.

Patients unresponsive to 131I should consider enrolling in clinical trials testing new approaches to treating this disease.