ATA Differentiated Thyroid Cancer Derivative

Differentiated Thyroid Cancer Management 8 50. A) Post-operative disease status (i.e. the presence or absence of persistent disease) should be considered in deciding whether additional treatment (e.g. radioactive iodine, surgery, or other treatment) may be needed. (SR-L) B) Post-operative serum thyroglobulin (on thyroid hormone therapy or after TSH stimulation) can help in assessing the persistence of disease or thyroid remnant and predicting potential future disease recurrence. The Tg should reach its nadir by 3–4 weeks post- operatively in most patients. (SR-M) C) The optimal cut-off value for post-operative serum thyroglobulin or state in which it is measured (on thyroid hormone therapy or after TSH stimulation) to guide decision-making regarding RAI administration is not known (NR-I) D) Post-operative diagnostic radioiodine whole-body scans may be useful when the extent of the thyroid remnant or residual disease cannot be accurately ascertained from the surgical report or neck ultrasonography, and when the results may alter the decision to treat, or the activity of RAI that is to be administered. Identification and localization of uptake foci may be enhanced by concomitant SPECT/CT. When performed, pretherapy diagnostic scans should utilize 123 I (1.5–3 mCi) or a low activity of 131 I (1–3 mCi), with the therapeutic activity optimally administered within 72 hours of the diagnostic activity. (WR-L) 54. A) In patients with ATA low risk and ATA intermediate risk DTC without extensive lymph node involvement (i.e. T1–T3, N0/Nx/N1a, M0), in whom radioiodine remnant ablation or adjuvant therapy is planned, preparation with rhTSH stimulation is an acceptable alternative to thyroid hormone withdrawal for achieving remnant ablation, based on evidence of superior short-term quality of life, non-inferiority of remnant ablation efficacy, and multiple consistent observations suggesting no significant difference in long-term outcomes. (SR-M) B) In patients with ATA intermediate risk DTC who have extensive lymph node disease (multiple clinically-involved LN) in absence of distant metastases, preparation with rhTSH stimulation may be considered as an alternative to thyroid hormone withdrawal, prior to adjuvant radioactive iodine treatment (WR-L) C) In patients with ATA high risk DTC with attendant higher risks of disease-related mortality and morbidity, more controlled data from long-term outcome studies are needed before recombinant human thyrotropin preparation for RAI adjuvant treatment can be recommended. (NR-I)

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