ATA Guidelines Tools

DTC: Long-Term Management and Advanced Cancer Management 28 74. There are currently insufficient outcome data to recommend rhTSH- mediated therapy for all patients with distant metastatic disease being treated with 131 I. (NR-I) 75. Recombinant human TSH–mediated therapy may be indicated in selected patients with underlying co-morbidities making iatrogenic hypothyroidism potentially risky, in patients with pituitary disease who are unable to raise their serum TSH, or in patients in whom a delay in therapy might be deleterious. Such patients should be given the same or higher activity that would have been given had they been prepared with hypothyroidism or a dosimetrically determined activity. (SR-L) 76. Since there are no outcome data that demonstrate a better outcome of patients treated with lithium as an adjunct to 131 I therapy, the data are insufficient to recommend lithium therapy. (NR-I) 77. A) Pulmonary micrometastases should be treated with RAI therapy repeated every 6–12 months as long as disease continues to concentrate RAI and respond clinically, because highest rates of complete remission are reported in these subgroups. (SR-M) B) The selection of RAI activity to administer for pulmonary micrometastases can be empiric (100–200 mCi, or 100–150 mCi for patients >70 yo) or estimated by dosimetry to limit whole-body retention to 80 mCi at 48 hours and 200 cGy to the bone marrow. (SR-M) 78. Radioiodine-avid macronodular metastases may be treated with RAI and treatment may be repeated when objective benefit is demonstrated (decrease in the size of the lesions, decreasing Tg), but complete remission is not common and survival remains poor. The selection of RAI activity to administer can be made empirically (100–200 mCi) or by lesional dosimetry or whole-body dosimetry if available in order to limit whole-body retention to 80 mCi at 48 hours and 200 cGy to the bone marrow. (WR-L) 79. A) RAI therapy of iodine-avid bone metastases has been associated with improved survival and should be employed, although RAI is rarely curative. (SR-M) B) The RAI activity administered can be given empirically (100–200 mCi) or determined by dosimetry. (WR-L) 80. In the absence of structurally evident disease, patients with stimulated serum Tg <10 ng/mL with thyroid hormone withdrawal or <5 ng/mL with rhTSH (indeterminate response) can be followed without empiric RAI therapy on with continued thyroid hormone therapy alone, reserving additional therapies for those with rising serum Tg levels over time or other evidence of structural disease progression. (WR-L)

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