"However, there is incomplete knowledge about how and why care was delivered in hospitals showing variation." For example, the database that the researchers used did not explain patient preferences or physician reasoning for why it may not have been given to a high-risk patient or why it was given to a low-risk one.
"Some surgeons leave a rim of thyroid tissue adjacent to nerves to minimize the risk of nerve injury, and rely on RAI to ablate the residual thyroid tissue," Livingston and McNutt argued. " Such surgeons have made a conscious risk-benefit decision balancing nerve injury with the risks of RAI."
They added, "these scenarios fall into the realm of individual clinician judgment and decision making. Consequently, variation is to be expected."
Haymart, however, said that the guidelines' indication for RAI is related to disease, "not whether there is thyroid tissue around the nerve."
In conclusion, Haymart and colleagues wrote that while radioactive iodine after surgery "is appropriate therapy for certain well-differentiated thyroid cancers, the benefit of radioactive iodine may not always exceed the risks.
"There is a clear role for adjuvant therapy with radioactive iodine in iodine-avid, advanced stage, well-differentiated thyroid cancer; however, there is unclear benefit to radioactive iodine use in low risk disease because patients with low-risk disease have an excellent prognosis, regardless of intervention."
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