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Differentiated Thyroid Cancer

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15 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 A) If thyroid hormone withdrawal is planned prior to RAI therapy or diagnostic testing, levothyroxine should be withdrawn for 3–4 weeks. Liothyronine (LT3) may be substituted for levothyroxine in the initial weeks if levothyroxine is withdrawn for ≥4 weeks, and in such circumstances, LT3 should be withdrawn for ≥2 weeks.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)

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