Key Points
2
➤ Differentiated thyroid cancer (DTC) includes papillary, follicular, and
oncocytic carcinomas, comprising the vast majority (>90%) of all
thyroid cancers.
• The goal of this pocket guide is to assist in the management of adult patients
with DTC, emphasizing the patient journey beginning with a thyroid cancer
diagnosis.
Table 1. Guideline Grading System
Strength of Recommendation Certainty of Evidence
S Strong Recommendation* H High-quality evidence
C Conditional Recommendation M Moderate-quality evidence
GPS Good Practice Statement L Low-quality evidence*
VL Very low evidence*
In Insufficient evidence to determine
benefits and/or harms
* Strong recommendations are only indicated when certainty is low or very low in limited
circumstances.
General Definitions
Active Surveillance
➤ The ongoing observation or active monitoring of a known or suspected
primary, intrathyroidal, low-risk DTC with serial imaging as an
alternative to upfront surgical intervention. This is a type of expectant
management and is only appropriate for a subset of low-risk DTCs
(see Recommendation 11). This does not pertain to persistent or
recurrent thyroid cancer, in which case the term "monitoring" is
employed (see below). Some proportion of patients who undergo active
surveillance may be recommended to pursue thyroid surgery if there is
concern for disease progression or based on patient preference.
Disease Monitoring
➤ Monitoring for biochemical (elevated level of serum thyroglobulin
[Tg]) and/or structural persistence or recurrence of disease (as
confirmed by imaging and/or biopsy) following the diagnosis and
initial treatment (surgery ± radioactive iodine [RAI] of thyroid cancer).
It is deployed to evaluate patients for disease progression and inform
the type and timing of interventions deemed appropriate.
