ATA Guidelines Tools

13 Surveillance And Follow Up Î Children with DTC may experience adverse psychosocial effects and be nonadherent with LT4 therapy. Attention to these possibilities and supportive counseling as required are important adjuncts in the long- term follow up of children with DTC. Future studies on the impact of a DTC diagnosis and treatment on quality of life in children are required. (C) Î Recurrence of DTC in children has been reported as long as 40 years after initial therapy. For that reason, children with DTC should be followed for life, albeit with decreasing intensity for those with no evidence for disease. (B) Î Tg serves as a sensitive tumor marker in the evaluation, treatment, and long-term follow up of DTC in children, even in children not previously treated with 131 I. TgAb levels should be simultaneously measured in all samples as the presence of TgAb will render the Tg result uninterpretable. Tg and TgAb levels should be measured using the same laboratory and assay technique. The trend in serial Tg and/or TgAb levels is much more informative in regard to determining disease status than any single measurement. (A) Î An undetectable TSH-stimulated Tg (with negative TgAb) identifies patients in remission with a very high probability to remain completely free of disease during follow-up and in whom the intensity of disease surveillance and the magnitude of TSH suppression should be relaxed. Monitoring the TSH-suppressed Tg level on LT4 treatment is the recommended approach to long-term follow-up, with the trend of this value being the most reliable indicator of disease activity. Repeat TSH- stimulated Tg levels are not necessary if the TSH-suppressed Tg is detectable or if a previous TSH-stimulated Tg was undetectable. (A) Î Detection of a low-level TSH-stimulated Tg (<10 ng/ml) in a patient who has undergone surgery and therapeutic 131 I may indicate persistent disease. However, this value may decline over time without additional therapy. Continued follow up with serial TSH-suppressed Tg and TgAb levels as well as radiologic imaging (neck US) are indicated in this situation. (B) Î Increasing or frankly elevated levels of TSH-stimulated Tg (>10 ng/ml) warrant further evaluation to localize disease and inform the decision as to whether additional surgery and/or 131 I therapy would be beneficial or whether one should pursue continued observation. (A) Î The Tg level cannot be interpreted in children with positive TgAb. In this setting, the TgAb trend should be followed using the same assay. If the TgAb trend is clearly rising, then further evaluation is warranted. (A)

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