18
Treatment
Recommendation 44
A. Adjuvant external beam radiotherapy (EBRT) for DTC patients with
high-risk features for locoregional disease progression (such as
aggressive histologic subtype; gross extrathyroidal extension; positive
margins; and visceral or soft tissue invasion), may be considered in
select cases, especially if the expected disease progression would not
be amenable to salvage surgery. The potential benefit of improving
locoregional relapse-free survival must be weighed against the
absence of data demonstrating improvement in overall survival and
the known risks of clinically meaningful toxicity. (C-L)
B. EBRT with or without concurrent chemotherapy in DTC patients with
gross residual disease in the post-operative setting or with locally
advanced unresectable disease may be considered in select patients
who may benefit from improved locoregional control. EBRT with or
without concurrent chemotherapy may increase locoregional control
but also causes acute- and long-term treatment-related toxicity. (C-L)
Recommendation 45
➤ Individualization of decisions to initiate TSH suppression to below
the reference range is recommended based on potential benefits and
risks; recognizing that patients with high-risk disease may be more
likely to benefit from a TSH in the subnormal range than those with
low-risk disease (see Table 9). (C-L)
Recommendation 46
A. Long-term TSH suppression is not suggested for patients with low- or
intermediate-risk disease who have no evidence of biochemical or
structural recurrence. (C-L)
B. Risks versus benefits of TSH suppression and TSH goals should be
re-evaluated over time. (GPS)
Recommendation 47
A. Serum Tg should be measured by an assay that is calibrated against
the BCR457 standard. Tg antibodies should be quantitatively
assessed with every measurement of serum Tg. (GPS)
B. Measure serum Tg (on thyroid hormone therapy) after total
thyroidectomy, with or without RAI, to monitor for response to
therapy and to determine recurrence (although the predictive value
is greater after RAI). (S-M)
C. Measurement of serum Tg during initial follow-up while receiving
thyroxine therapy should be undertaken every six to 12 months.
More frequent serum Tg measurements may be appropriate for ATA
intermediate-high or high-risk patients. (GPS)
