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Papillary cancer of the thyroid is a lymphophile cancer which accounts for approximately 80% of thyroid cancers. Vesicular cancer, which is rathermore haematophile, represents approximately 15-20% of differentiated thyroid carcinoma.

Both types of cancers capture Iodine.

After radical thyroidectomy (with node sampling), isotopic screening is performed with a tracing dose of Iodine 131. If remaining thyroid tissues are visible on the scintigraphy, an ablative dose of 100 mCi of Iodine 131 is administered in order to deliver selective interstitial brachytherapy on this persistent thyroid tissue.

This treatment should be administered in a specialised hospital room with lead walls, specific toilets to collect contaminated urine and faeces and with particular precautions for dealing with underwear. Nursing and cleaning personnel should be protected by a dosimeter and elementary measures like remaining at a distance from the patient.

If the initial isotopic screening is positive, further screening will be carried out approximately 6 months later. Substitutive hormone therapy should be interrupted in order to obtain correct fixation on the thyroid tissue situated either around the neck or at remote metastases.

In the course of this ablative treatment, constant reducing hormonotherapy should administered with two main goals:

To avoid hypothyroidism, which is very rapidly poorly tolerated by patients,

To block the TSH axis thus avoiding the development of metastases.

The TSH level should be lower than 0.02 mU/l. Thyroglobulin level should also be controlled.

As a substitutive treatment, T4 levothyroxine is the most frequently prescribed hormonotherapy at a dosage of 2-3 µg/kg/d or a mixture of T4 and T3 in order to correct the onset of hypothyroidism.