The treatment of differentiated thyroid cancer continues to move away from a 'one size fits all' approach to a process of tailored therapeutic decision-making that incorporates disease-specific factors and individual patient preferences. Management options range from active surveillance to thyroid lobectomy to total thyroidectomy with or without the use of postoperative radioactive iodine (RAI). RAI may be administered for one or more reasons: Thyroid remnant ablation, adjuvant therapy, or therapy for persistent structural disease. It is important to be cognizant of the therapeutic intent of RAI and weigh the risks and benefits of treatment for each individual patient. Risk stratification should be used to identify those patients who are most likely to benefit from RAI and guide therapeutic choices. Available data suggest that RAI can be safely deferred for most patients considered at low risk for structural recurrence, while adjuvant RAI is associated with improved disease-free survival in patients with higher-risk disease. Although progress has been made, many areas of uncertainty related to the use of RAI remain. These include: (1) The appropriate selection of intermediate-risk patients to receive adjuvant RAI, (2) the superiority or inferiority of different RAI dosing activities, (3) the optimal approach to the use of RAI in special populations, including patients with end-stage renal disease and children, and (4) the management of patients with RAI-refractory disease.

中文翻译：

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定制甲状腺癌放射性碘治疗的方法。

分化型甲状腺癌的治疗继续从“一刀切”的方法转向结合疾病特定因素和个体患者偏好的定制治疗决策过程。管理选择范围从主动监测到甲状腺叶切除术，再到全甲状腺切除术，使用或不使用术后放射性碘 (RAI)。RAI 可能出于一种或多种原因进行管理：残留甲状腺消融、辅助治疗或持续性结构性疾病的治疗。重要的是要认识到 RAI 的治疗意图，并权衡每个患者治疗的风险和益处。应使用风险分层来确定最有可能从 RAI 中受益的患者并指导治疗选择。现有数据表明，对于大多数被认为结构性复发风险低的患者，RAI 可以安全地推迟，而辅助 RAI 与高风险疾病患者的无病生存期改善相关。尽管已经取得了进展，但与使用 RAI 相关的许多不确定性领域仍然存在。These include: (1) The appropriate selection of intermediate-risk patients to receive adjuvant RAI, (2) the superiority or inferiority of different RAI dosing activities, (3) the optimal approach to the use of RAI in special populations, including patients with终末期肾病和儿童，以及 (4) RAI 难治性疾病患者的管理。而辅助 RAI 与高危疾病患者的无病生存期改善相关。尽管已经取得了进展，但与使用 RAI 相关的许多不确定性领域仍然存在。These include: (1) The appropriate selection of intermediate-risk patients to receive adjuvant RAI, (2) the superiority or inferiority of different RAI dosing activities, (3) the optimal approach to the use of RAI in special populations, including patients with终末期肾病和儿童，以及 (4) RAI 难治性疾病患者的管理。而辅助 RAI 与高危疾病患者的无病生存期改善相关。尽管已经取得了进展，但与使用 RAI 相关的许多不确定性领域仍然存在。These include: (1) The appropriate selection of intermediate-risk patients to receive adjuvant RAI, (2) the superiority or inferiority of different RAI dosing activities, (3) the optimal approach to the use of RAI in special populations, including patients with终末期肾病和儿童，以及 (4) RAI 难治性疾病患者的管理。