20
TMNG or TA
65. In patients who are at increased risk for complications due to
worsening of hyperthyroidism, resuming ATDs 3–7 days after RAI
administration should be considered. (W-L)
66. Nonfunctioning nodules on radionuclide scintigraphy or nodules
with suspicious ultrasound characteristics should be managed
according to published guidelines regarding thyroid nodules in
euthyroid individuals (http://www.thyroid.org/professionals/ata-
professional-guidelines/#). (S-M)
67. Sufficient activity of RAI should be administered in a single
application to alleviate hyperthyroidism in patients with TMNG.
(S-M)
68. Sufficient activity of RAI should be administered in a single
application to alleviate hyperthyroidism in patients with TA. (S-M)
69. Follow-up within the first 1–2 months after RAI therapy for TMNG
or TA should include an assessment of free T
4
, total T
3
and TSH.
Biochemical monitoring should be continued at 4–6 week intervals
for 6 months, or until the patient becomes hypothyroid and is stable
on thyroid hormone replacement. (S-L)
70. If hyperthyroidism persists beyond 6 months following RAI therapy
for TMNG or TA, retreatment with RAI is suggested. In selected
patients with minimal response 3 months after therapy additional
RAI may be considered. (W-L)
Surgery
71. If surgery is chosen as treatment for TMNG or TA, patients with
overt hyperthyroidism should be rendered euthyroid prior to the
procedure with MMI pretreatment, with or without β-adrenergic
blockade. Preoperative iodine should NOT be used in this setting.
(S-L)
72. If surgery is chosen as treatment for TMNG, near-total or total
thyroidectomy should be performed. (S-M)
73. Surgery for TMNG should be performed by a high-volume thyroid
surgeon. (S-M)
74. If surgery is chosen as the treatment for TA, a thyroid ultrasound
should be done to evalutate the entire thyroid gland. An ipsilateral
thyroid lobectomy, or isthmusectomy if the adenoma is in the
thyroid isthmus, should be performed for isolated TAs. (S-M)
75. The ATA suggests that surgery for TA be performed by a high-
volume surgeon. (W-M)
