Low iodine diet advice and differentiated thyroid cancer treatment: A historic exploration in three UK centres

  • Clare England
    Correspondence
    Corresponding author. NIHR Bristol Biomedical Research Centre Nutrition Theme, University of BristolLevel 3 UHBW Education and Research Centre, Upper Maudlin Street, Bristol, BS2 8AE, UK.
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK

    Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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  • Kate Ingarfield-Herbert
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK

    School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK

    Centre for Trials Research, College of Biomedical and Life Science, Cardiff University, UK
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  • Matthew Beasley
    Affiliations
    University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, UK
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  • Laura Moss
    Affiliations
    Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, UK
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  • Sobhan Vinjamuri
    Affiliations
    Department of Nuclear Medicine, The Royal Liverpool and Broadgreen University Hospital NHS Trust, Prescot Street, Liverpool, L7 8XP, UK
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  • Ingrid Haupt-Schott
    Affiliations
    Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, UK
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  • Gail McKane
    Affiliations
    Department of Nuclear Medicine, The Royal Liverpool and Broadgreen University Hospital NHS Trust, Prescot Street, Liverpool, L7 8XP, UK
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  • Linda Hunt
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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  • Georgia Herbert
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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  • Sam Leary
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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  • Andy Ness
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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  • Charlotte Atkinson
    Affiliations
    National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Published:November 23, 2021DOI:https://doi.org/10.1016/j.clnesp.2021.11.026

      Summary

      Background and aims

      Patients with differentiated thyroid cancer are often advised to follow a low iodine diet (LID) one to two weeks before radioiodine remnant ablation (RRA). We describe treatment practices and ablation success rates in centres (C1, C2, C3) in the UK with different approaches to LID advice.

      Methods

      Historic cohort of patients with differentiated thyroid cancer treated with RRA in 2015/16 in C1 (n = 50, 1-week LID), C2 (n = 59, 2-week LID) and C3 (n = 108, no LID advice). Response to RRA was stratified as excellent, indeterminate, or incomplete by the adapted American Thyroid Association Dynamic Risk Stratification Score.

      Results

      There was little difference in age, sex and staging between centres, but the percentage receiving 1.1 GBq vs higher administered activities differed (C1:22%, C2:44%, C3:15%, p < 0.001). Excellent response was recorded for: C1:48%, C2:36%, C3:49% (p = 0.61). Differences in RRA preparation and outcome assessment at C3 precluded comparison across all centres. Adjusted odds ratio for excellent response at C2 vs C1 was 0.57 (95%CI: 0.25,1.32), p = 0.19.

      Conclusions

      There was no evidence that advising a LID for 2-weeks before RRA improves outcomes compared to 1-week. For definitive recommendations on LIDs prior to RRA, a prospective multi-centre study with a more homogenous approach to patient management or, randomised controlled trial, is needed.

      Keywords

      Abbreviations:

      DTC (Differentiated thyroid cancer), LID (Low iodine diet), rhTSH (Recombinant human thyroid stimulating hormone), RRA (Radioiodine remnant ablation), THW (Thyroid hormone withdrawal), TSH (Thyroid stimulating hormone), UIC (Urine iodine concentration (units = mcg/l)), UI/Cr (Urine iodine creatinine ratio (an alternate way of expressing iodine status, units = mcg/g)), UIE (Urine iodine excretion (units = mcg/l))
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