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Background <p>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).</p> Methods <p>This retrospective cohort study included 136 DTC patients classified as IDR 6&#xa0;months after initial RAI therapy. Patients were categorized into a Retreatment Group (<i>n</i> = 18), who received additional RAI treatment, and a Follow-up Group (<i>n</i> = 118), managed with active surveillance. Treatment response was assessed during follow-up.</p> Results <p>The rate of excellent response (ER) was significantly higher in the Follow-up Group compared to the Retreatment Group (58.47% vs. 33.33%, <i>P</i> = <i>0.046</i>). In the Follow-up Group, multivariate analysis identified older age (≥ 45.50&#xa0;years; OR, 1.07; <i>P</i> &lt; <i>0.001</i>), lateral cervical lymph node metastasis (N1b; OR, 2.92; <i>P</i> = <i>0.016</i>), and higher stimulated thyroglobulin (sTg) level at first follow-up (≥ 2.025&#xa0;ng/mL; OR, 1.31; <i>P</i> &lt; <i>0.001</i>) 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).</p> Conclusion <p>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.</p>

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Comparative outcomes of retreatment vs follow-up in DTC patients with intermediate response following initial radioactive iodine therapy: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月31日

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  • Jiaxin Miao,
  • Wensi Cheng,
  • Lin Ding,
  • Hongliang Fu,
  • Yafu Yin,
  • Shuo Huang,
  • Weiwei Cheng

摘要

Background

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).

Methods

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.

Results

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).

Conclusion

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.