ATA Guidelines Tools

9 Recommendation 13 ➤ For patients undergoing active surveillance, routine measurement of serum Tg and/or TgAb levels is not recommended. (GPS) Recommendation 14 ➤ In patients undergoing active surveillance, surgical resection is indicated if there is evidence of new biopsy-proven lymph node metastases, growth of the primary tumor by ≥3 mm, distant metastases, evidence of extrathyroidal extension, posterior growth, when there is patient anxiety, inability to follow-up, and/or expressed preference for surgery. (GPS) Recommendation 15 A. When resection is performed for patients with thyroid cancer ≤2 cm without gross extra-thyroidal extension (cT1) and without metastases (cN0M0), the initial surgical procedure should be a thyroid lobectomy unless there are bilateral cancers or other indications to remove the contralateral lobe. (S-M) B. For patients with low risk, unilateral thyroid cancer >2 and ≤4 cm (cT2N0M0), thyroid lobectomy may be the preferred initial surgical treatment due to significantly lower risk and side effects. However, the patient and treatment team may adopt total thyroidectomy to enable RAI administration and/or enhance follow-up based on disease features, suspicious contralateral nodularity, and/or patient preferences. When thyroid lobectomy is offered as initial treatment, counsel the patient about the possibility of conversion to total thyroidectomy or need for subsequent completion thyroidectomy if higher-risk factors emerge intraoperatively or postoperatively. (C-L/M) C. For patients with thyroid cancer >4 cm (cT3a), cancer of any size with gross extra-thyroidal extension (cT3b or cT4), or clinically apparent metastatic disease to lymph nodes (cN1) or distant sites (cM1), the initial surgical procedure should include a total thyroidectomy with gross removal of all primary tumor and node dissection unless there are contraindications to this procedure. (C-M) Recommendation 16 A. Completion thyroidectomy for cancer following initial lobectomy may be considered to address persistent primary malignancy, facilitate RAI administration, and/or enhance follow-up based upon higher estimated risk of recurrence identified postoperatively, accounting for recurrent laryngeal nerve (RLN) function. (C-L/M) B. Completion thyroidectomy for oncocytic thyroid carcinoma (OTC) may be considered based on indications like other histological types of DTC. (C-VL)

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