Physicians’ preferences for radioiodine treatment of differentiated thyroid cancer in Brazil: an observational study

Padovani, Rosália do Prado; Pansani, Isabella Fagian; Marone, Marília Martins Silveira; Vaisman, Fernanda; Maia, Ana Luiza Silva; Dora, José Miguel Silva; Ramos, Helton Estrela; Hoff, Ana Amélia Fialho de Oliveira; Coura Filho, George Barbério

doi:10.20945/2359-4292-2023-0228

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Archives of Endocrinology and Metabolism

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ORIGINAL ARTICLE • Arch. Endocrinol. Metab. 68 • 2024 • https://doi.org/10.20945/2359-4292-2023-0228 copy

Physicians’ preferences for radioiodine treatment of differentiated thyroid cancer in Brazil: an observational study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The aim of this observational, cross-sectional study was to investigate physicians’ preferences for radioiodine (RAI) treatment in patients with differentiated thyroid cancer (DTC) in Brazil and the factors influencing RAI indications.

Materials and methods

A survey was distributed to physicians potentially involved in DTC care in Brazil to understand the factors influencing RAI indications. The survey collected information on the profiles of the physicians, along with the characteristics of their workplaces and their preferences regarding RAI indications in three hypothetical clinical cases. Cases 1, 2, and 3 described the cases of patients with DTC and variations to the case that included different scenarios to assess how the respondents would change their RAI recommendations. The analysis included the RAI indications across different medical specialties.

Results

A total of 175 physicians answered the survey. There was considerable variability in RAI recommendations in all three cases. The training background influenced the respondents' preferences for RAI indications and their approaches to preparing patients for RAI treatment.

Conclusion

The findings of this study reaffirm the need for a Brazilian consensus among physicians across multiple specialties to help guide health care professionals treating patients with DTC in Brazil.

Keywords
Thyroid nodule; thyroid neoplasms; radiopharmaceuticals; thyroid cancer, papillary thyroid carcinoma; thyrotropin; thyroid diseases

Case 1	A 45-year-old female patient with a 2.0 cm papillary thyroid carcinoma with a follicular variant histology without any other features.
Case 2	A patient with a follicular carcinoma measuring 3.5 cm with invasion of two or five blood vessels.
Case 3	A patient with a tall-cell variant of papillary thyroid carcinoma with two metastatic level VI lymph nodes (1.2 and 0.6 cm) who underwent radioiodine treatment with an activity of 100 mCi in the previous year and has a rising serum thyroglobulin of 109 ng/mL. The patient has no evidence of disease on cervical ultrasound and chest computed tomography shows scattered micronodules.

	Head and neck surgeons versus Endocrinologists	Endocrinologists versus Nuclear medicine physicians	Head and neck surgeons versus Nuclear medicine physicians
Case 1	p < 0.05	p < 0.05	p < 0.05
Case 1 but male sex	p < 0.05	p < 0.05	p < 0.05
Case 1 but age 55 years	p < 0.05	p < 0.05	p < 0.05
Case 1 but sTg of 12 ng/mL	p < 0.05	NS	p < 0.05
Case 1 but positive anti-TgAb	p < 0.05	NS	p < 0.05
Case 1 but with an aggressive histological variant	p < 0.05	NS	p < 0.05
Case 1 but with one additional micropapillary focus in the same lobe	NS	p < 0.05	p < 0.05
Case 1 but with one additional micropapillary focus in the opposite lobe	NS	p < 0.05	p < 0.05
Case 1 but with four additional metastatic ipsilateral central neck lymph nodes < 3 mm	NS	NS	NS
Case 1 but with at least one metastatic central neck lymph node of 1.0 cm	p < 0.05	NS	NS
Case 1 but with bilateral central neck metastases < 3 mm	p < 0.05	NS	NS
Case 1 but with at least one ipsilateral metastatic lateral neck lymph node	p < 0.05	NS	p < 0.05
Case 1 but with bilateral metastatic lateral neck lymph nodes	p < 0.05	NS	p < 0.05
Case 1 but with minimal extrathyroidal extension	p < 0.05	NS	p < 0.05
Case 1 but with vascular invasion	NS	NS	NS
Case 1 but with perithyroidal muscle invasion	NS	NS	NS

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

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[1] Correspondence to: Isabella Fagian Pansani Rua José Lins do Rego, 665, Parque Taquaral 13087-221 – Campinas, SP, Brasil isabella.pansani@hotmail.com