Treatment
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Recommendation 78
A. In RAIR DTC patients with symptomatic and/or multiple bone
metastases, treatment with a bone modifying agent is recommended
to decrease the risk of skeletal-related events. (S-L)
B. A bone-modifying agent dosing schedule of every 3 months may
be considered due to a reduction in the risk of adverse events,
especially osteonecrosis of the jaw, compared to monthly dosing, but
may increase the risk of symptomatic skeletal events. (C-L)
Recommendation 79
A. Resection and/or stereotactic body radiotherapy (SBRT) are the
mainstays of therapy for central nervous system metastases. (C-L)
B. RAI can be considered if central nervous system metastases
concentrate RAI. If RAI is planned, SBRT and concomitant
glucocorticoid therapy are recommended prior to RAI therapy to
minimize the effects of a potential TSH induced increase in tumor
size and RAI induced inflammatory response. (GPS)
Recommendation 80
➤ Patients should be counseled to consider enrolling in prospective
clinical trials based upon specific eligibility requirements for
given studies and the likelihood that the patient will benefit from
participation. Clinicians considering referral of patients for trials
should review available treatment options and eligibility criteria,
preferably through discussions with personnel at the trial center and
review of materials at the website www.clinicaltrials.gov. (GPS)
Considerations Managing Pregnant Patients With DTC
Recommendation 81
A. In most pregnant patients, surgery can be safely delayed until after
delivery. Exceptions include rare patients for whom there is concern
for significant disease progression. If necessary, surgery may be
performed in the second trimester of pregnancy. (C-L)
B. For pregnant patients diagnosed with DTC during pregnancy,
monitoring with neck ultrasound at least once in early second
trimester and more often if clinically indicated is appropriate. Cross-
sectional imaging using MRI may be performed in selected cases.
Imaging modalities that require ionizing radiation should not be
performed other than in exceptional circumstances. (C-L)
