Differentiated Thyroid Cancer Management
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Table 4. Response to Therapy Re-Classification
Excellent response An excellent response to therapy should lead to a decrease
in the intensity and frequency of follow up and the degree
of TSH suppression.
Note: This change in management will be most apparent in
ATA intermediate and high risk patients.
Biochemical incomplete
response
If associated with stable or declining serum Tg values, a
biochemical incomplete response should lead to continued
observation with ongoing TSH suppression in most
patients. Rising Tg or Tg antibody values should prompt
additional imaging and potentially additional therapies.
Structural incomplete
response
A structural incomplete response may lead to additional
treatments or ongoing observation depending on multiple
clinico-pathologic factors including the size, location,
rate of growth, RAI avidity,
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FDG avidity, and specific
patholog y of the structural lesions.
Indeterminate response An indeterminate response should lead to continued
observation with appropriate serial imaging of the non-
specific lesions and serum Tg monitoring. Non-specific
findings that become suspicious over time or rising Tg or Tg
antibodies levels can be further evaluated with additional
imaging or biopsy.
Guideline Grading System
Strength of Recommendation Quality of Evidence
SR Strong Recommendation H High-quality evidence
WR Weak Recommendation M Moderate-quality evidence
NR No Recommendation L Low-quality evidence
I Insufficient evidence
