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Differentiated Thyroid Cancer

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11 Table 5. Clinical Implications of Response To Therapy Re-Classification in Differentiated Thyroid Cancer Patients Treated With Total Thyroidectomy and RAI Remnant Ablation Category Definitions Clinical Outcomes Management Implications Excellent Response Negative imaging and either Suppressed Tg <0.2 ng/mL a OR TSH stimulated Tg<1 ng/mL a • 1-4% recurrence • <1% disease specific death An excellent response to therapy should lead to an early decrease in the intensity and frequency of follow up and the degree of TSH suppression. Biochemical Incomplete Response Negative imaging AND Suppressed Tg >1 ng/mL a OR Stimulated Tg >10 ng/mL a OR Rising Tg Ab levels • At least 30% spontaneously evolve to NED • 20% achieve NED after additional therapy • 20% develop structural disease • <1% disease specific death If associated with stable or declining serum Tg values, a biochemical incomplete response should lead to continued observation with ongoing TSH suppression in most patients. Rising Tg or Tg antibody values should prompt additional investigations and potentially additional therapies.

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