ATA Guidelines Tools

23 C) For low risk patients who have undergone remnant ablation and have undetectable serum Tg levels, TSH may be maintained at the lower end of the reference range (0.5–2 mU/L) while continuing surveillance for recurrence. Similar recommendations hold for low- risk patients who have not undergone remnant ablation and have undetectable serum Tg levels. (WR-L) D) For low risk patients who have undergone remnant ablation and have low level serum Tg levels, TSH may be maintained at or slightly below the lower limit of normal (0.1–0.5 mU/L) while continuing surveillance for recurrence. Similar recommendations hold for low-risk patients who have not undergone remnant ablation, although serum Tg levels may be measurably higher and continued surveillance for recurrence applies. (WR-L) E) For low risk patients who have undergone lobectomy, TSH may be maintained in the mid to lower reference range (0.5–2 mU/L) while continuing surveillance for recurrence. Thyroid hormone therapy may not be needed if patients can maintain their serum TSH in this target range. (WR-L) 60. There is no role for routine adjuvant external beam radiation therapy to the neck in patients with DTC after initial complete surgical removal of the tumor (SR-L). 61. There is no role for routine systemic adjuvant therapy in patients with DTC (beyond RAI and/or TSH suppressive therapy using levothyroxine). (SR-L) 62. A) Serum thyroglobulin should be measured by an assay that is calibrated against the CRM457 standard. Thyroglobulin antibodies should be quantitatively assessed with every measurement of serum Tg. Ideally, serum Tg and Tg antibodies should be assessed longitudinally in the same laboratory and using the same assay for a given patient. (SR-H) B) During initial follow-up, serum Tg on thyroxine therapy should be measured every 6–12 months. More frequent Tg measurements may be appropriate for ATA high risk patients. (SR-M) C) In ATA low and intermediate risk patients that achieve an excellent response to therapy, the utility of subsequent Tg testing is not established. The time interval between serum Tg measurements can be lengthened to at least ≥12–24 months. (WR-L) D) Serum TSH should be measured at least every 12 months in all patients on thyroid hormone therapy. (SR-ML) E) ATA high risk patients (regardless of response to therapy) and all patients with biochemical incomplete, structural incomplete, or indeterminate response should continue to have Tg measured at least every 6–12 months for several years. (WR-L)

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