ATA Guidelines Tools

27 70. A) In patients with a structural or biochemical incomplete response to therapy, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absence of specific contraindications. (SR-M) B) In patients with a biochemical incomplete response to therapy, the serum TSH should be maintained between 0.1–0.5 mU/L, taking into account the initial ATA risk classification, Tg level, Tg trend over time and risk of TSH suppression. (WR-L) C) In patients with an excellent (clinically and biochemically free of disease) or indeterminate response to therapy, but who presented with high risk disease, consideration should be given to maintaining thyroid hormone therapy to achieve serum TSH levels of 0.1–0.5 mU/L for ≤5 years after which the degree of TSH suppression can by reduced with continued surveillance for recurrence. (WR-L) D) In patients with an excellent (clinically and biochemically free of disease) or indeterminate response to therapy, especially those at low risk for recurrence, the serum TSH may be kept within the low reference range (0.5–2 mU/L). (SR-M) E) In patients who have not undergone remnant ablation or adjuvant therapy who demonstrate an excellent or indeterminate response to therapy with a normal neck US, and low or undetectable suppressed serum Tg, and Tg or TgAb that are not rising, the serum TSH can be allowed to rise to the low reference range (0.5–2 mU/L). (WR-L) 71. Therapeutic compartmental central and/or lateral neck dissection in a previously operated compartment, sparing uninvolved vital structures, should be performed for patients with biopsy-proven persistent or recurrent disease for central neck nodes ≥8 mm and lateral neck nodes ≥10 mm in the smallest dimension which can be localized on anatomic imaging. (SR-M) 72. When technically feasible, surgery for aerodigestive invasive disease is recommended in combination with RAI and/or external beam radiotherapy. (SR-M) 73. A) Although there are theoretical advantages to dosimetric approaches to the treatment of loco-regional or metastatic disease, no recommendation can be made about the superiority of one method of RAI administration over another (empiric high activity vs. blood and/or body dosimetry vs. lesional dosimetry). (NR-I) B) Empirically administered amounts of 131 I exceeding 150 mCi that often potentially exceed the maximum tolerable tissue dose should be avoided in patients >70 years. (SR-M)

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