***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim of this study is to compare the effectiveness of  131I therapy between three groups of DTC patients who received 30 , 60 or 100 mCi for thyroid remnant ablation after total thyroidectomy and were postoperatively judged with low risk of cancer recurrence . Methods The project was design ed as a two-stage , prospect i ve r and omized clinical trial . In 1998 - 2001 in a r and omized prospect i ve study the early comparison of treatment with 30 mCi vs 60 mCi suggested the lower 131I activity to be less effective , whereas in 2003 - 2005 the comparison between 60 vs 100 mCi showed no significant differences . The present study comprises the long-term assessment of the disease course in 3 study groups . Results A group of 309 DTC patients ( 285 women and 24 men ) with no clinical , histopathological , sonographical or biochemical signs of persistent disease were included after total thyroidectomy and appropriate extent of neck lymph node dissection ( 265 with papillary and 44 with follicular thyroid cancer ) . For radioiodine thyroid remnant ablation , 30 mCi of 131I was applied in 86 patients , whereas 60 mCi in 128 and 100 mCi in 95 patients . The median follow-up was 10 years ( 2 - 12 ) for subjects treated with 30 mCi and 60 mCi and 6 years ( 2 - 6 ) for patients treated with 100 mCi of 131I . In the first evaluation , published previously , we observed that because of incomplete thyroid remnant ablation , the second 131I treatment was necessary in 10 % patients , without difference between groups treated with 60 and 100 mCi and in 22 % patients treated with 30 mCi . All patients entered full remission . To evaluate the long-term outcome of the adjuvant 131I treatment , the course of the follow-up and the most recent disease status were assessed by sonography , radiological examinations and serum Tg estimation ( on LT4-suppressive treatment ) . Within the whole observation period local relapse was stated in 2 ( 2.4 % ) , 4 ( 3 % ) and 3 ( 3 % ) patients treated with 131I activities of 30 mCi , 60 mCi and 100 mCi respectively and serum Tg concentration on LT4-suppressive treatment was low , without differences between groups . Conclusions No significant differences in the 5 years efficacy of thyroid remnant radioiodine ablation using 30 , 60 and 100 mCi were observed in low-risk DTC patients operated by total thyroidectomy and neck lymph node dissection . However , patients treated initially with 30 mCi , required second course of radioiodine in 22 % , while this was necessary only in 13,3 % and 11,2 % of patients treated with 60 mCi and 100 mCi respectively BACKGROUND Despite very low mortality associated with micropapillary thyroid cancer , locoregional recurrence is common and controversy exists regarding optimal surgical treatment and the role of adjunctive radioiodine . METHODS The National Thyroid Cancer Treatment Cooperative Study Group Registry was analyzed for recurrences in patients with unifocal versus multifocal micropapillary cancer , with or without nodal disease , depending upon the extent of surgery and the use of adjunctive radioiodine .  Six hundred eleven patients considered disease-free after initial therapy were followed for 2572 person-years . RESULTS Thirty patients ( 6.2 % ) had recurrences  detected at a mean 2.8 years after primary treatment . Recurrences did not differ between patients with unifocal and multifocal disease overall ; however , among patients who received less than a near-total thyroidectomy ( NTT ) , those with multifocal disease had more recurrences than those with unifocal disease ( 18 % vs. 4 % , p = 0.01 ) . Patients with multifocal disease who had a total ( T ) or NTT trended toward fewer recurrences than those undergoing less than an NTT ( 6 % vs. 18 % , p = 0.058 ) . In patients who did not receive radioiodine therapy , recurrence was more common in patients with multifocal disease versus unifocal disease ( 7 % vs. 2 % , p = 0.02 ) . However , radioiodine did not reduce recurrences in patients with multifocal disease or patients with positive nodes . Patients with positive nodes had more recurrences than node-negative patients regardless of surgical extent or use of radioiodine . CONCLUSIONS Patients with micropapillary multifocal disease have a reduced risk of recurrence after a T/NTT compared with less surgery . A r and omized , controlled trial is necessary and feasible to determine if radioiodine ablation of thyroid remnants is advantageous in patients with intrathyroidal micropapillary cancer BACKGROUND It is not clear whether the administration of radioiodine provides any benefit to patients with low-risk thyroid cancer after a complete surgical resection . The administration of the smallest possible amount of radioiodine would improve care . METHODS In our r and omized , phase 3 trial , we compared two thyrotropin-stimulation methods ( thyroid hormone withdrawal and use of recombinant human thyrotropin ) and two radioiodine ( (131)I ) doses ( i.e. , administered activities ) ( 1.1 GBq and 3.7 GBq ) in a 2-by-2 design . Inclusion criteria were an age of 18 years or older ; total thyroidectomy for differentiated thyroid carcinoma ; tumor-node-metastasis ( TNM ) stage , ascertained on pathological examination ( p ) of a surgical specimen , of pT1 ( with tumor diameter ≤1 cm ) and N1 or Nx , pT1 ( with tumor diameter > 1 to 2 cm ) and any N stage , or pT2N0 ; absence of distant metastasis ; and no iodine contamination . Thyroid ablation was assessed 8 months after radioiodine administration by neck ultrasonography and measurement of recombinant human thyrotropin-stimulated thyroglobulin . Comparisons were based on an equivalence framework . RESULTS There were 752 patients enrolled between 2007 and 2010 ; 92 % had papillary cancer . There were no unexpected serious adverse events . In the 684 patients with data that could be evaluated  , ultrasonography of the neck was normal in 652 ( 95 % ) , and the stimulated thyroglobulin level was 1.0 ng per milliliter or less in 621 of the 652 patients ( 95 % ) without detectable thyroglobulin antibodies . Thyroid ablation was complete in 631 of the 684 patients ( 92 % ) . The ablation rate was equivalent between the (131)I doses and between the thyrotropin-stimulation methods . CONCLUSIONS The use of recombinant human thyrotropin and low-dose ( 1.1 GBq ) postoperative radioiodine ablation may be sufficient for the management of low-risk thyroid cancer . ( Funded by the French National Cancer Institute [ INCa ] and the French Ministry of Health ; Clinical Trials.gov number , NCT00435851 ; INCa number , RECF0447 . ) Abstract . Impairment of the lacrimal gl and s after external radiation has been well documented , but there are only a few reports on the effects of radioiodine therapy on the lacrimal gl and s. Long-term effects of high-dose radioiodine therapy on tear secretion have not previously been studied . We investigated 175 eyes of 88 patients with a history of radioiodine therapy for thyroid carcinoma ( 68 females , 20 males ; mean age 55±16 years , range 17–81 years ) and compared them with a sex- and age-matched control group ( n=39 ) . All patients had been given at least 2.96 GBq iodine-131 ( maximal administered activity 22.3 GBq 131I ) . An ophthalmological investigation was performed 64±71 months ( range 3–317 months ) after initial radioiodine therapy by a single ophthalmologist . Lacrimal gl and function was evaluated with three different function tests . External eye morphology was considered , and detailed ophthalmological history-taking was performed . Patients with factors known to affect lacrimal gl and function ( contact lenses , autoimmune disorders , history of additional radiation exposure ) were excluded from the study . A total of 81 patients ( 92 % ) had at least one abnormal function test indicating impaired lacrimal gl and function . Schirmer 's tear test was decreased ( < 10 mm/5 min ) in 47 of the 88 patients and definitely abnormal ( < 5 mm/5 min ) in 35 patients . A tear film break-up time of < 10 s was found in 78 patients , and 62 patients had a definitely abnormal break-up time of < 5 s. The lacrimal lipid layer was impaired in 43 patients . The function tests were all significantly altered in the study group as compared with the controls ( P<0.005 , P<0.001 , P<0.001 , respectively ) . Both subjective symptoms of dry eye ( P<0.01 ) and changes in the external eye morphology ( P<0.001 ) were significantly more prevalent in the study group . Our findings suggest that in the majority of patients , lacrimal gl and function may be permanently impaired after high-dose radioiodine therapy . All three layers of the tear film are involved and there is a pronounced long-term effect on the tear film stability Purpose The purpose of the study was to determine the diagnostic impact of 131I-SPECT/CT imaging compared with conventional scintigraphic evaluation in the follow-up of patients with thyroid carcinoma . Methods Seventy-one patients with thyroid carcinoma underwent concurrent 131I-SPECT/CT , using an integrated imaging system , at various stages of their disease in order to evaluate foci of uptake detected on planar whole-body images . Results SPECT/CT imaging had an incremental diagnostic value in 57 % ( 41/71 ) of patients . Uptake in the neck was evaluated in 61 patients , and SPECT/CT imaging in this region had an incremental diagnostic value in 27 % of the whole patient population ( 19/71 ) . Low-resolution integrated CT images allowed for the precise characterization of equivocal neck lesions on planar imaging in 14/17 patients and changed the assessment of the lesion location in five patients as compared with planar studies . Thirty-six patients underwent SPECT/CT for evaluation of foci of uptake distant from the neck . SPECT/CT imaging improved characterization of equivocal foci of uptake as definitely benign in 13 % ( 9/71 ) of patients . Precise localization of malignant lesions to the skeleton was possible in 17 % ( 12/71 ) and to the lungs versus the mediastinum in 6 % ( 5/71 ) of patients . Conclusion Integrated 131I-SPECT/CT was found to have an additional value over planar imaging in patients with thyroid cancer for correct characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization of malignant lesions in the neck , chest , and skeleton . SPECT/CT optimized the localization of 131I uptake to lymph node metastases versus remnant thyroid tissue , to lung versus mediastinal metastases , and to the skeleton . It also had a further clinical impact on patient management by influencing referral for 131I treatment , tailoring of the administered radioiodine dose , and /or the addition of surgery or external radiation therapy when indicated CONTEXT Although the prognosis of papillary thyroid microcarcinoma ( PTMC ) is usually excellent , the optimal follow-up strategy has never been investigated . OBJECTIVE The objective of the study was to investigate the role of  neck ultrasonography ( US ) , whole-body scintigraphy ( WBS ) , and serum thyroglobulin levels ( Tg ) after recombinant human ( rh ) TSH in the follow-up of very low-risk PTMC patients . DESIGN The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy . SETTING The study population consisted of ambulatory patients . PATIENTS Eighty consecutive patients diagnosed with PTMC , who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies , were included . MAIN OUTCOME MEASURES WBS and Tg after both rhTSH and neck US  were measured . RESULTS  rhTSH-Tg  was 1 ng/ml or less in 45 ( Tg- ) and more than 1 in 35 ( Tg+ ) patients . WBS showed no pathological uptake in any patient . US identified node metastases in two Tg ( + ) and one Tg ( - ) patients . rhTSH-Tg levels positively correlated with thyroid bed iodine uptake ( r = 0.40 , P < 0.0001 ) . To date ( 32 + /- 13 months after surgery ) , all node-negative patients have undetectable Tg levels on LT(4 ) treatment and negative US . CONCLUSIONS For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment : 1 ) WBS is useless ; 2 ) US is highly sensitive in detecting node 
    Output:
    
RESULTS Neck ultrasonography is superior to whole-body scan for disease detection in the neck .
A rising or declining serum thyroglobulin level over time provides an excellent positive or negative predictive value , respectively , even in non-RRA-treated patients .
Neck ultrasonography and serum thyroglobulin measurement are equivalent or superior in detecting and localizing residual disease compared to post-therapy whole-body scan .
There is no evidence of RRA benefit in recurrence prevention for LR patients .