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Differentiated Thyroid Cancer

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DTC: Long-Term Management and Advanced Cancer Management 10 Figure 1. Clinical Decision-making and Management Recommendations in ATA Low Risk Differentiated Thyroid Cancer Patients That Have Undergone Total Thyroidectomy Initial Therapy Total Thyroidectomy (R35) RAI Remnant Ablation Not Routinely Recommended (R51A, Table 6) If done, 30 mCi is generally favored over higher administered activities (R55) Evaluation of Post-Operative Disease Status • Routine use of post-op serum thyroglobulin (R50B, R50C) • Post-op diagnostic RAI scanning (R50D) and/or untrasound may be considered Initial TSH Goal • If non-stimulated Tg <0.2 ng/mL (excellent response), maintain TSH of 0.5–2 mU/L (R59C) • If non-stimulated Tg ≥0.2 ng/mL (indeterminate or incomplete response), maintain TSH of 0.1–0.5 mU/L (R59D) Evalutation Response to Therapy • Tg testing (R62, R63, R64) • Neck US (R65) • Diagnostic whole body scan not routinely recommended (R66) Excellent Response to Therapy • Primary follow-up with clinical exam and non-stimulated Tg (R65D, 63A, 63B)) • TSH goal 0.5–2.0 mU/L (R70C, R70D, Table 8) • Non-stimulated Tg 12-24 month intervals (R62C) • Periodic US examinations (R65) Biochemical Incomplete (rising serum Tg), Structural Incomplete, or Indeterminate Response See text for guidance

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