DTC: Long-Term Management and
Advanced Cancer Management
16
Figure 3. Clinical Decision-making and Management
Recommendations in ATA Intermediate Risk Differentiated
Thyroid Cancer Patients That Have Undergone Total
Thyroidectomy
Initial Therapy
• Total thyroidectomy (R35)
• Therapeutic neck dissection (clinical NI disease) (R36A)
• +/- Prophylactic central neck dissection (R36B)
RAI Should Be Considered (R51D, Table 6)
• For remnant ablation, 30 mCi is generally favored over higher administered
activities (R55)
• For adjuvant therapy, administered activities above remnant ablation up to
150 mCi are generally recommended (in absence of known distant metastases)
(R56)
Evaluation of Post-Operative Disease Status
• Routine use of post-op serum thyroglobulin (R50B)
• Post-op diagnosis RAI scanning (R50D) and/or ultrasound
may be considered
Initial TSH Goal
0.1–0.5 mU/L (R59B)
Evalutation Response to Therapy (R49)
• Tg testing (R62, R63A, R64)
• Neck US (R65)
• Consider diagnostic whole body scan (R66, R67)
Excellent Response to Therapy
• TSH goal 0.5-2.0 mU/L (R70D, Table 8)
• Non-stimulated Tg 12-24 month intervals
(R62C)
• Periodic US examinations (R65)
Biochemical Incomplete,
Structural Incomplete,
or Indeterminate Response
See text for guidance
