9
Figure 2. Initial Postoperative Staging for ATA Pediatric
Intermediate- and High-Risk Pediatric Thyroid Carcinoma
Distant metastases
(no cervical uptake
outside of thyroid bed)
Stimulated
Tg
1
<2 ng/mL
No or only minimal
thyroid bed uptake
Cervical uptake outside
of thyroid bed
(± distant metastases)
Stimulated
Tg
1
2-10 ng/mL
Stimulated
Tg
1
>10 ng/mL
Imaging
2
to identify
possible resectable disease
and surgical consult
No or minimal
residual disease not
amenable to surgery
Significant residual
disease amenable
to surgery
Surgery
5
131
I therapy & post-
treatment scan &/or
LT4 suppression
3,4
131
I not
indicated
3
131
I therapy &
post-treatment
scan
Surveillance
6
1
Assumes a negative TgAb and a TSH >30 mIU/L. In TgAb-positive patients, consideration can be
given (except in patients with T4 tumors or clinical M1 disease) to deferred evaluation to allow time
for TgAb clearance ("delayed" staging ).
2
Imaging includes neck ultrasonography±SPECT/CT at the time of the diagnostic thyroid scan.
3
Consider
131
I in patients with thyroid bed uptake and T4 tumors or known residual microscopic
cervical disease.
4
While there are no prospective studies in patients ≤18 years of age, the use of
131
I remnant ablation
may not decrease the risk for persistent or recurrent disease. Consider surveillance rather than
131
I
with further therapy determined by surveillance data.
5
Repeat postoperative staging 3-6 months aer surgery.
6
See Table 3 and Figures 3 and 4.
123
I diagnostic whole body scan
& TSH-stimulated Tg
1
