RAI for stage 1 papillary or not?

[12345sandy]

Thanks for this helpful site.  I had a tt last week for what was found to be stage 1 papillary carcinoma follicular variant. 7 year history of Hashimotos, multinodular monitored every year with US.  Path showed 3 lesions: 1 on right lobe 9x5x3mm and 2 on left 1mm and 4mm.  Neg nodes. No family history of thyroid or any autoimmune disorders. No history of radiation. Excellent health. 41 years old.  My surgeon said she would have RAI, even if it were unifocal.  My endo advises against RAI citing there is no evidence to show that it proves beneficial to stage 1'ers.  He said Mayo/Sloan and others would probably advise against RAI in my case.  Washington Hospital Center and others would probably be for it.  He calls it a "grey" area.  He mentioned briefly that if I did decide to take RAI I may consider a smaller dose.  Could you please direct me to the latest recommendations and provide your opinion on?
Would you advise RAI for my case?  If so, how much?  
Is 30mci enough to ablate remenant tissue (estimated 5percent remains).  
What are the stats on increases in breast, bladder, other cancers after RAI treatments?  
What and how effective are monitoring tools for non RAI patients? (US, does Tg work with antibodies, TSH)
What are percentage recurrence rates in Stage 1'ers w/ vs w/out RAI?  W/ 30 vs 150mci doses?
Is there any harm in waiting to do RAI or are there benefits to being done post op?

My endo says "we don't want the cure to be worse than the disease".  I'm now in cytomel limbo trying to decipher ATA guidelines and mounds of other literature to make an informed decision.  would love to have your thoughts.  Thanks!

[Mark Lupo, M.D.]

Many of these are un-answered questions.  There is a slight risk of other cancers after RAI.  There is some evidence that multifocal microcancers can spread but in general the consensus is either observe without RAI or use a 30-50mCi dose.  Observation with serial ultrasound and Tg levels is reliable (in proper hands -- ie a good physician ultrasonographer) and RAI can be delayed (usually we try to do within a year of surgery).

Current ATA guidelines suggest consideration of RAI for multifocal disease -- for "peace of mind" I have treated many patients in this situation with low-moderate RAI doses.  I usually use thyrogen, not withdrawal from thyroid hormone for RAI treatments.

[crucian]

I am in that exact situation.  My endo works for Johns Hopkins Outpatient Center and like you, he thinks that I do not need RAI at this time.  He cited my age (38), stage 1 papillary, negative nodes, TT and good health, no family history and no prior medical problems, as reasons not to have RAI.  It was suggested that suppression would be best for me at this time.