35
Table 10. Summary of Recommendations for Initial RAI
Following Thyroidectomy
a
Risk category
Typical RAI
recommendation
Recommended
131
I
activity level Goals of therapy
Low No 1.1–1.85 GBq
(30–50 mCi)
None or remnant
ablation
Intermediate-low and
intermediate-high
Consider 1.1–3.7 GBq
(30–100 mCi)
Remnant ablation
+/– adjuvant therapy
High Yes 3.7–5.55 GBq
(100–150 mCi)
Remnant ablation
and adjuvant therapy
Distant metastases Yes 3.7–7.4 GBq
(100–200 mCi) or
consider dosimetry
Treatment of known
disease, remnant
ablation
a
Note that these recommendations represent guidelines, and that a variety of additional features
including patient preference, comorbid conditions, access to care, pre-therapy imaging, and others
may influence the decision to treat with RAI as well as the resulting activity level. Consistent with
the Martinique documents, the final recommendation for administered activity should be based on
multidisciplinary management recommendations.
Table 11. Low-risk DTC With Excellent Response to Therapy
De-escalation Recommendations
Treatment and
response to therapy
Unstimulated
thyroglobulin TSH
Suggested frequency of
neck ultrasound
Hemithyroidectomy Once post-operatively
(See Rec 48)
Normal
a
Every 1–3 years for 5–8 years
Total thyroidectomy,
no RAI
Excellent response
<2.5 ng/mL with
undetectable TgAb
Normal Every 1–3 years for 5–8 years,
then discontinue unless Tg
level rises or TgAb becomes
newly detectable
Total thyroidectomy
+ RAI
Excellent response
<0.2 ng/mL with
undetectable TgAb
Normal Every 1–3 years for 5–8
years and then discontinue
unless Tg level rises or TgAb
becomes newly detectable
Recommendations on ultrasound monitoring in low-risk patients aer total thyroidectomy with
excellent biochemical response and no suspicious features on imaging. Imaging is indicated in
patients with rising thyroglobulin (Tg ), new development of anti-thyroglobulin antibodies (TgAb),
concerning physical exam, or symptoms. Type and location of imaging depends on the histological
type of thyroid cancer and other patholog y features. Use of Tg levels following hemithyroidectomy,
and use of neck ultrasound in patients with FTC and OTC require further study.
a
Assuming no nodules in residual lobe requiring monitoring as per ATA thyroid nodule guidelines.
