Thyroid Nodules and Differentiated Thyroid Cancer -- Differentiated Cancer
D) Nodules >2 cm in greatest dimension with very low suspicion sonographic pattern (e.g., – spongiform). Observation without FNA is also a reasonable option. (WR, M)
E) Nodules that do not meet the above criteria. (SR, M)
Differentiated Thyroid Cancer
High Moderate-quality evidence
DTC: Long-Term Management and Advanced Cancer Management
a) a significant medical or psychiatric condition that could be acutely exacerbated with hypothyroidism leading to a serious adverse event, or
b) inability to mount an adequate endogenous TSH response with thyroid hormone withdrawal.
a) as part of initial staging in poorly differentiated thyroid cancers and invasive Hürthle cell carcinomas, especially those with other evidence of disease on imaging or because of elevated serum Tg levels,
b) as a prognostic tool in patients with metastatic disease to identify lesions and patients at highest risk for rapid disease progression and disease-specific mortality, and
c) as an evaluation of posttreatment response following systemic or local therapy of metastatic or locally invasive disease.
a) in the setting of bulky and widely distributed recurrent nodal disease where ultrasound may not completely delineate disease,
b) in the assessment of possible invasive recurrent disease where potential aerodigestive tract invasion requires complete assessment or
c) when neck ultrasound is felt to be inadequately visualizing possible neck nodal disease (high Tg, negative neck US).
A) The malignant/metastatic tissue does not ever concentrate radioiodine (no uptake outside the thyroid bed at the first diagnostic or therapeutic WBS).
B) The tumor tissue loses the ability to concentrate radioiodine after previous evidence of RAI-avid disease (in the absence of stable iodine contamination).
C) Radioiodine is concentrated in some lesions but not in others.
D) Metastatic disease progresses despite significant concentration of radioiodine.
When a patient with DTC is classified as refractory to radioiodine, there is no indication for further radioiodine treatment. ( WR , L )
94. While surgical resection and stereotactic external beam radiotherapy are the mainstays of therapy for CNS metastases, RAI can be considered if CNS metastases concentrate RAI. If RAI is being considered, stereotactic external beam radiotherapy and concomitant glucocorticoid therapy are recommended prior to RAI metastases concentrate RAI. If RAI is being considered, stereotactic external beam radiotherapy and concomitant glucocorticoid therapy are recommended prior to RAI therapy to minimize the effects of a potential TSH-induced increase in tumor size and RAI-induced inflammatory response.( WR , L )
Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer
January 12, 2016
Supplemental Implementation Tools
External Publication Status
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Our objective in these guidelines is to inform clinicians, patients, researchers, and health policy makers about the best available evidence (and its limitations), relating to the diagnosis and treatment of adult patients with thyroid nodules and DTC.
Target Patient Population
Adults with DTC
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient, Radiology services
Nurse, nurse practitioner, physician, physician assistant
Counseling, Assessment and screening, Diagnosis, Prevention, Management, Treatment
differentiated thyroid cancer (DTC), thyroid nodules, DTC, Thyroid Cancer