Differentiated Thyroid Cancer Management
4
Figure 1. Clinical Decision-making and Management
Recommendations in ATA Low Risk Differentiated Thyroid
Cancer Patients That Have Undergone Total Thyroidectomy
Initial Therapy
Total Thyroidectomy (R35)
RAI Remnant Ablation Not Routinely Recommended (R51A, Table 6)
If done, 30 mCi is generally favored over higher administered activities (R55)
Evaluation of Post-Operative Disease Status
• Routine use of post-op serum thyroglobulin (R50B, R50C)
• Post-op diagnostic RAI scanning (R50D) and/or untrasound may
be considered
Initial TSH Goal
• If non-stimulated Tg <0.2 ng/mL (excellent response), maintain TSH of
0.5–2 mU/L (R59C)
• If non-stimulated Tg ≥0.2 ng/mL (indeterminate or incomplete response),
maintain TSH of 0.1–0.5 mU/L (R59D)
Evaluation Response to Therapy
• Tg testing (R62, R63, R64)
• Neck US (R65)
• Diagnostic whole body scan not routinely recommended (R66)
Excellent Response to Therapy
• Primary follow-up with clinical exam and
non-stimulated Tg (R65D, 63A, 63B)
• TSH goal 0.5–2.0 mU/L
(R70C, R70D, Table 8)
• Non-stimulated Tg 12-24 month intervals
(R62C)
• Periodic US examinations (R65)
Biochemical Incomplete
(rising serum Tg),
Structural Incomplete,
or Indeterminate Response
See text for guidance
