DTC: Long-Term Management and
Advanced Cancer Management
20
Figure 4. Clinical Decision-making and Management
Recommendations in ATA High Risk Differentiated Thyroid
Cancer Patients That Have Undergone Total Thyroidectomy
and Have No Gross Residual Disease Remaining in the Neck
Initial Therapy
• Total thyroidectomy (R35)
• Therapeutic neck dissection (clinical N1 disease) (R36A)
• +/- Prophylactic central neck dissection (R36B)
RAI Routinely Recommended (R51E, Table 1)
• For adjuvant therapy, administered activities above remnant ablation up to 150
mCi are generally recommended (in absence of known distant metastases) (R56)
• For known structural disease, empiric 100–200 mCi, (100-150 mCi for
patients >70 yo) or dosimetry-guided dosing (R77, R78, R79)
Evaluation of Post-Operative Disease Status
• Routine use of post-op serum thyroglobulin (R50B)
• Post-op diagnostic RAI scanning (R50D) and/or ultrasound
may be considered
Initial TSH Goal
<0.1 mU/L (R59A)
Evalutation Response to Therapy (R49)
• Tg testing (R62B, R62E)
• Neck US (R65)
• Consider CT/MRI imaging (R69A-C) and/or FDG/PET scanning (R68)
• Consider diagnostic whole body scan (R67)
Excellent Response to Therapy
• TSH 0.1-0.5 for at least 5 yrs
(R70C)
• Yearly follow-up and Tg for at least
5 years (R62E)
• Consider periodic US/CT/MRI
Biochemical Incomplete, Structural
Incomplete, or Indeterminate
Response
• TSH goal <0.1 indefinitely in
the absence of contraindications
(R70A)
• See text for guidance
