ATA Guidelines Tools

DTC: Long-Term Management and Advanced Cancer Management 22 Table 7. Response to Therapy Re-Classification Excellent response An excellent response to therapy should lead to a decrease in the intensity and frequency of follow up and the degree of TSH suppression Note: This change in management will be most apparent in ATA intermediate and high risk patients. Biochemical incomplete response If associated with stable or declining serum Tg values, a biochemical incomplete response should lead to continued observation with ongoing TSH suppression in most patients. Rising Tg or Tg antibody values should prompt additional imaging and potentially additional therapies. Structural incomplete response A structural incomplete response may lead to additional treatments or ongoing observation depending on multiple clinico-pathologic factors including the size, location, rate of growth, RAI avidity, 18 FDG avidity, and specific patholog y of the structural lesions. Indeterminate response An indeterminate response should lead to continued observation with appropriate serial imaging of the non- specific lesions and serum Tg monitoring. Non-specific findings that become suspicious over time or rising Tg or Tg antibodies levels can be further evaluated with additional imaging or biopsy. 56. When RAI is intended for initial adjuvant therapy to treat suspected microscopic residual disease, administered activities above those used for remnant ablation ≤150 mCi are generally recommended (in absence of known distant metastases). It is uncertain whether routine use of higher administered activities ( >150 mCi) in this setting will reduce structural disease recurrence for T3 and N1 disease. (WR-L) 57. A low-iodine diet for approximately 1–2 weeks should be considered for patients undergoing RAI remnant ablation or treatment. (WR-L) 58. A post-therapy whole-body scan (with or without single-photon emission tomography/computed tomography [SPECT-CT]) is recommended after RAI remnant ablation or treatment to inform disease staging and document the RAI-avidity of any structural disease. (SR-L) 59. A) For high-risk thyroid cancer patients, initial TSH suppression to below 0.1 mU/L is recommended. (SR-M) B) For intermediate-risk thyroid cancer patients, initial TSH suppression to 0.1–0.5 mU/L is recommended. (WR-L)

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