ATA Guidelines Tools

21 54. A) In patients with ATA low risk and ATA intermediate risk DTC without extensive lymph node involvement (i.e. T1–T3, N0/Nx/N1a, M0), in whom radioiodine remnant ablation or adjuvant therapy is planned, preparation with rhTSH stimulation is an acceptable alternative to thyroid hormone withdrawal for achieving remnant ablation, based on evidence of superior short-term quality of life, non-inferiority of remnant ablation efficacy, and multiple consistent observations suggesting no significant difference in long-term outcomes. (SR-M) B) In patients with ATA intermediate risk DTC who have extensive lymph node disease (multiple clinically-involved LN) in absence of distant metastases, preparation with rhTSH stimulation may be considered as an alternative to thyroid hormone withdrawal, prior to adjuvant radioactive iodine treatment (WR-L) C) In patients with ATA high risk DTC with attendant higher risks of disease-related mortality and morbidity, more controlled data from long-term outcome studies are needed before recombinant human thyrotropin preparation for RAI adjuvant treatment can be recommended. (NR-I) D) In patients with DTC of any risk level with significant co- morbidity that may preclude thyroid hormone withdrawal prior to iodine radioiodine administration, recombinant human thyrotropin preparation should be considered. Significant co-morbidity may include: a) a significant medical or psychiatric condition that could be acutely exacerbated with hypothyroidism leading to a serious adverse event, or b) inability to mount an adequate endogenous TSH response with thyroid hormone withdrawal. (SR-L) 55. A) If radioactive iodine remnant ablation is performed after total thyroidectomy for ATA low risk thyroid cancer or intermediate risk disease with lower risk features (i.e., low volume central neck nodal metastases with no other known gross residual disease nor any other adverse features), a low administered dose activity of approximately 30 mCi is generally favored over higher administered dose activities. (SR-H) B) Higher administered activities may need to be considered for patients receiving less than a total or near-total thyroidectomy where a larger remnant is suspected or where adjuvant therapy is intended. (WR-L)

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