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51. A) RAI remnant ablation is not routinely recommended after
thyroidectomy for ATA low risk DTC patients. Consideration of
specific features of the individual patient that could modulate
recurrence risk, disease follow-up implications, and patient
preferences, are relevant to RAI decision-making. (WR-L)
B) RAI remnant ablation is not routinely recommended after
lobectomy or total thyroidectomy for patients with unifocal papillary
microcarcinoma, in the absence of other adverse features. (SR-M)
C) RAI remnant ablation is not routinely recommended after
thyroidectomy for patients with multi-focal papillary microcarcinoma,
in absence of other adverse features. Consideration of specific
features of the individual patient that could modulate recurrence
risk, disease followup implications and patient preferences, are
relevant to RAI decision-making. (WR-L)
D) RAI adjuvant therapy should be considered after total
thyroidectomy in ATA intermediate risk level differentiated thyroid
cancer patients. (WR-L)
E) RAI adjuvant therapy is routinely recommended after total
thyroidectomy for ATA high risk differentiated thyroid cancer
patients. (SR-M)
52. The role of molecular testing in guiding post-operative RAI use has
yet to be established, therefore no molecular testing to guide post-
operative RAI use can be recommended at this time. (NR-I)
53. A) If thyroid hormone withdrawal is planned prior to RAI therapy
or diagnostic testing, levothyroxine should be withdrawn for 3–4
weeks. Liothyronine (LT3) may be substituted for levothyroxine in the
initial weeks if levothyroxine is withdrawn for ≥4 weeks, and in such
circumstances, LT3 should be withdrawn for ≥2 weeks. Serum TSH
should be measured prior to radioisotope administration to evaluate
the degree of TSH elevation. (SR-M)
B) A goal TSH of >30 mIU/L has been generally adopted in
preparation for RAI therapy or diagnostic testing, but there is
uncertainty relating to the optimum TSH level associated with
improvement in long-term outcomes. (WR-L)
