15
D. Suspicious lymph nodes or lesions <8–10 mm in shortest dimension
may be followed without FNA unless they grow or threaten vital
structures (such as the recurrent laryngeal nerve, trachea,
esophagus, or great vessels). (C-L)
E. If cytological diagnosis of recurrent or metastatic DTC would
influence treatment decisions or change management,
ultrasonographically suspicious lymph nodes or lesions ≥8–10 mm
in the shortest dimension should be assessed with FNA for cytology
and measurement of Tg in the needle washout fluid. (GPS)
F. When Tg (or TgAb) levels rise following total thyroidectomy for DTC,
and cervical ultrasound demonstrates no structural disease or
only minimal tumor burden, additional cross-sectional imaging to
evaluate common metastatic sites (e.g., lungs and bone) should be
performed. (GPS)
G. When Tg (or TgAb) levels rise following total thyroidectomy for OTC
and PDTC, and cervical US demonstrates no structural disease
or shows only minimal tumor burden,
18
FDG-PET/CT may be
considered. (C-L)
Recommendation 32
A. Remnant ablation is not recommended routinely after total
thyroidectomy for ATA low-risk DTC patients. (S-H)
B. RAI adjuvant therapy may be considered after total thyroidectomy
in patients with ATA low-intermediate and intermediate-high risk of
recurrent DTC. (C-L)
C. RAI adjuvant therapy is recommended routinely after total
thyroidectomy for patients with ATA high-risk DTC. (S-M)
D. In patients with an initial diagnosis of DTC with distant metastases,
RAI therapy is recommended routinely after total thyroidectomy.
(S-M)
Recommendation 33
➤ Outcomes data are limited in OTC; thus, specific recommendations
regarding use of RAI are not certain. If RAI is not administered
empirically, evaluation of iodine avidity with a diagnostic whole-body
scan may be considered. (C-VL)
