ATA Guidelines Tools

29 81. Empiric (100–200 mCi) or dosimetrically-determined radioactive iodine therapy may be considered in patients with more significantly elevated serum Tg levels, rapidly rising serum Tg levels or rising Tg antibody levels, in whom imaging (anatomic neck/chest imaging and/or 18 FDG-PET/CT) has failed to reveal a tumor source that is amenable to directed therapy. The risk of high cumulative administered activities of RAI must be balanced against uncertain long-term benefits. If empiric RAI therapy is given and the post- therapy scan is negative, the patient should be considered to have RAI-refractory disease and no further RAI therapy should be administered. (WR-L) 82. If persistent nonresectable disease is localized after an empiric dose of RAI, and there is objective evidence of significant tumor reduction, then consideration can be made for RAI therapy to be repeated until the tumor has been eradicated or the tumor no longer responds to treatment. The risk of repeated therapeutic doses of RAI must be balanced against uncertain long-term benefits. (WR-L) 83. The evidence is insufficient to recommend for or against the routine use of measures to prevent salivary gland damage after RAI therapy. (NR-L) 84. Patients with xerostomia are at increased risk of dental caries and should discuss preventive strategies with their dental/oral health professional dentist. (WR-L) 85. Surgical correction should be considered for nasolacrimal outflow obstruction, which often presents as excessive tearing (epiphora) but also predisposes to infection. (SR-L) 86. Although patients should be counseled on the risks of second primary malignancy (SPM) with RAI treatment for DTC, the absolute increase in risk of developing second primary malignancy attributable to RAI treatment is considered small and does not warrant specific screening for SPMs to any extent greater than age- appropriate general population health screening. (WR-L) 87. Patients receiving therapeutic doses of RAI should have baseline complete blood count (CBC) and assessment of renal function. (WR-L) 88. Women of childbearing age receiving RAI therapy should have a negative screening evaluation for pregnancy prior to RAI administration and avoid pregnancy for 6–12 months after receiving RAI. (SR-L) 89. Radioactive iodine should not be given to nursing women. Depending on the clinical situation, RAI therapy could be deferred until lactating women have stopped breast-feeding or pumping for at least 3 months. A diagnostic 123 I or low dose 131 I scan should be considered in recently lactating women to detect breast uptake that may warrant deferral of therapy. (SR-L)

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