The ESTIMABL2 trial evaluated low-dose versus standard-dose radioactive iodine (RAI) ablation after thyroidectomy for low-risk differentiated thyroid cancer. What was its main conclusion?
- A 1.1 GBq RAI is superior to 3.7 GBq in achieving excellent response
- B Low-dose 1.1 GBq RAI with recombinant human TSH was non-inferior to 3.7 GBq in achieving successful ablation ✓
- C RAI ablation should be omitted entirely in all low-risk patients
- D Thyroid hormone withdrawal is necessary to achieve adequate ablation even at low doses
Correct answer: B. Low-dose 1.1 GBq RAI with recombinant human TSH was non-inferior to 3.7 GBq in achieving successful ablation
Explanation
The ESTIMABL2 trial (and its companion HiLo trial) demonstrated that low-activity RAI (1.1 GBq/30 mCi) combined with recombinant human TSH (rhTSH) stimulation was non-inferior to high-activity RAI (3.7 GBq/100 mCi) for successful ablation in low-risk differentiated thyroid cancer, with fewer side effects and equal quality of life. This supports the current ATA guideline recommendation to use low-dose RAI with rhTSH when adjuvant treatment is deemed necessary in low-risk patients, and supports active surveillance without any RAI in truly low-risk cases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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