Use of Radioactive Iodine for Thyroid Cancer – NCDB and SEER Data

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Study Overview:
    • Citation:
      • Haymart MR, Banerjee M, Stewart AK, Koenig RJ, Birkmeyer JD, Griggs JJ. Use of radioactive iodine for thyroid cancer. JAMA. 2011;306(7):721–728. 
    • Type:
      • Observational cohort using the National Cancer Database (NCDB) and SEER registries from 2004 to 2008
    • Population:
      • 189,219 adult patients with well-differentiated thyroid cancer (papillary or follicular) who underwent total thyroidectomy at 981 U.S. cancer centers
    • Objectives:
      • Analyze trends in RAI usage from 1990 to 2008
      • Identify patient-, tumor-, and hospital-level predictors of RAI administration
      • Assess variation in use across centers, adjusted for disease severity
  • Key Findings:
    • Rising Use Over Time
    • RAI utilization increased significantly across all tumor sizes between 1990 and 2008
    • Variation Driven by Non-Clinical Factors
    • Patient / tumor characteristics explained ~21% of variation in RAI use
    • Hospital traits (type, volume) accounted for ~17%, and 29% remained unexplained, suggesting practice pattern influence
  • Disease Stage and Use:
    • Compared to Stage IV:
      • Patients with Stage I disease were much less likely to receive RAI (OR 0.34), but Stage II / III use was similar to Stage IV (OR ~1)
  • Regional Disparities:
    • Rate of RAI use for low-, medium-, and high-risk disease varied by region (49% to 66%):
      • Indicating inconsistency in treatment approaches 
  • Clinical Implications:
    • Overuse concern:
      • Increasing RAI use even in low-risk settings raises questions about overtreatment
    • Practice patterns matter:
      • Institutional priorities and physician preferences strongly influenced whether patients received RAI, beyond tumor biology
    • Guideline alignment needed:
      • The lack of deficit-stage conformity highlights a need to standardize RAI delivery based on risk stratification, not provider bias
    • Takeaway for Expert Surgeons:
      • Recognize that RAI is often employed inconsistently, even for Stage II to III disease, despite limited evidence of benefit in these groups
      • Encourage benchmarking and quality initiatives within institutions to ensure RAI administration aligns with ATA risk-based guidelines
      • Educate multidisciplinary teams that evidence-based risk stratification should dictate RAI use, minimizing unnecessary exposure for patients with lower-stage disease
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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