Thyroid Nodules and Differentiated Thyroid Cancer Differentiated Cancer
Key Points
Key Points
Preoperative neck US is recommended for all patients undergoing thyroid surgery for malignant or suspicious FNA cytology or molecular findings (recommendation 32)
Preoperative cross-sectional imaging (CT or MRI) is recommended for patients with clinical suspicion of advanced disease (recommendation 33)
Patients with thyroid cancer that is 1-4 cm and no preoperative evidence of clinically apparent lymph nodes or extrathyroidal extension can be treated with thyroidectomy or lobectomy (recommendation 35)
Perioperative voice assessment is important in management of patients with DTC (recommendations 39-45)
For uniform reporting and appropriate risk assessment, pathology reports should include TNM status, unfavorable or favorable histopathologic variants, assessment of vascular invasion, number of LN examined and involved as well as size of largest involved LN and assessment of extranodal invasion (recommendation 46)
The ATA Initial Risk Stratification System is recommended for patients with DTC (recommendation 48)
ATA defined response to therapy should be continually assessed to determine the ongoing risk of recurrence (recommendations 49, 62 and 63)
Radioiodine (RAI) should be considered as remnant ablation, adjuvant therapy or therapy, and many patients with low risk disease do not require RAI remnant ablation (recommendation 51)
In patients with low and intermediate risk DTC, preparation for RAI ablation or adjuvant therapy with rhTSH is an acceptable alternative to thyroid hormone withdrawal (recommendation 54)
Lower administered RAI activities (approximately 30 mCi) are generally favored for patients with ATA low risk and intermediate risk disease with lower risk features (recommendation 55)
Monitoring approaches and TSH targets should be modified by the ATA response to therapy re-classification (recommendations 62-70)
RAI-refractory DTC is classified (recommendation 91)
Patients with RAI-refractory DTC should be carefully evaluated for ongoing monitoring (on TSH-suppressive thyroid hormone therapy), directed therapy (including surgery, radiation or thermal ablation), approved systemic therapy or entry into a clinical trial (recommendations 92-96)
Patients considered for kinase inhibitor therapy should be carefully counseled on the benefits and risks of therapy and carefully monitored during therapy (recommendations 96-98)
Differentiated Thyroid Cancer
...rentiated Thyroid Cancer...
...perative neck US for cervical (central and esp...
...ded FNA of sonographically suspicious lymph nodes...
...C) The addition of FNA-Tg washout i...
...eoperative use of cross-sectional imaging studie...
...utine preoperative 18FDG-PET scanning is NOT r...
...eoperative measurement of serum Tg or Tg...
.... Ultrasound Features of Lymph Nodes Pred...
...h edition/TNM Classification System for Di...
Treatment
...eatment...
...5. A) For patients with thyroid cancer...
...patients with thyroid cancer >1 cm and...
...5. C) If surgery is chosen for patients with thy...
...apeutic central-compartment (level...
...B) Prophylactic central-compartment neck diss...
...tomy without prophylactic central neck dis...
...tic lateral neck compartmental lymph...
...Completion thyroidectomy should be offered...
...Radioactive iodine ablation in lieu of...
...o surgery, the surgeon should communicate with t...
...undergoing thyroid surgery should...
...operative voice abnormalities (SR, M)623...
...cervical or upper chest surgery, which places th...
...Known thyroid cancer with posterio...
...Visual identification of the recurrent...
...rative neural stimulation (with or wit...
Table 3. Pre-operative Factors Which May Be As...
...3. The parathyroid glands and their blood supp...
...atients should have their voice assessed...
...t intraoperative findings and details of post-op...
...addition to the basic tumor features re...
...hologic variants of thyroid carcinoma associ...
...) Histopathologic variants associa...
...CC staging is recommended for all patients with D...
48. A) The 2009 ATA Initial Risk Str...
...itional prognostic variables (such as the exte...
48. C) While not routinely recommended for i...
...sponse to Therapy Exce...
DTC: Long-Term Management and Advanced Cancer Management
DTC: Long-Term Management and Advanc...
.... Clinical Decision-making and Management Rec...
...Clinical Implications of Response To Therapy Re-C...
49. Initial recurrence risk estimat...
...operative disease status (i.e. the presence...
...rative serum thyroglobulin (on thyroid ho...
...mal cut-off value for post-operative serum...
...-operative diagnostic radioiodine whole-...
...2. Clinical Decision-making and Management Reco...
...nt ablation is not routinely recommended after th...
...nt ablation is not routinely recommended...
...nant ablation is not routinely reco...
...djuvant therapy should be considered after...
...E) RAI adjuvant therapy is routinel...
...molecular testing in guiding post-operat...
...3. A) If thyroid hormone withdrawal is...
...H of >30 mIU/L has been generally adopted in prep...
.... Clinical Decision-making and Management...
...acteristics According to the ATA Ri...
...4. Clinical Decision-making and Management Rec...
...tients with ATA low risk and ATA int...
...patients with ATA intermediate risk DT...
...n patients with ATA high risk DTC wit...
...nts with DTC of any risk level with significant...
...adioactive iodine remnant ablation is perf...
...ministered activities may need to be...
...esponse to Therapy Re-ClassificationHaving t...
56. When RAI is intended for initial adjuvant...
...low-iodine diet for approximately 1–2 weeks sh...
...t-therapy whole-body scan (with or without...
...high-risk thyroid cancer patients, initial...
...B) For intermediate-risk thyroid cance...
55. C) For low risk patients who have undergone r...
...D) For low risk patients who have undergone r...
...risk patients who have undergone lobe...
60. There is no role for routine adjuv...
...ere is no role for routine systemic adjuvant ther...
...erum thyroglobulin should be measur...
...During initial follow-up, serum Tg...
...low and intermediate risk patients...
...D) Serum TSH should be measured at least every...
...ATA high risk patients (regardless of r...
...A) In ATA low-risk and intermediat...
...t TSH stimulated Tg testing is not r...
...quent TSH stimulated Tg testing may be cons...
...Periodic serum Tg measurements on t...
...Following surgery, cervical US to evaluate...
65. B) If a positive result would change manag...
...Suspicious lymph nodes...
...D) Low-risk patients who have had remnant ablat...
...ter the first post-treatment WBS performed f...
...tic WBS, either following thyroid hormone...
...-CT radioiodine imaging is preferred over pla...
...scanning should be considered in high ris...
.... B) 18FDG-PET scanning may also be considered...
69. A) Cross-sectional imaging of the n...
...B) CT imaging of the chest without...
...Imaging of other organs including MRI brain,...
...H Targets for Long-term Thyroid Hormo...
...patients with a structural or biochemica...
...tients with a biochemical incomplete r...
...ents with an excellent (clinically and biochem...
...tients with an excellent (clinically and...
...In patients who have not undergone re...
71. Therapeutic compartmental central and/...
72. When technically feasible, surgery for aerod...
...there are theoretical advantages to dosime...
...pirically administered amounts of 131I excee...
.... There are currently insufficient outcome data to...
...binant human TSH–mediated therapy may be indi...
...nce there are no outcome data that...
...nary micrometastases should be treated with RAI...
77. B) The selection of RAI activity to ad...
78. Radioiodine-avid macronodular m...
...) RAI therapy of iodine-avid bone metastases has...
...I activity administered can be given empirical...
...0. In the absence of structurally ev...
...(100–200 mCi) or dosimetrically-determined...
...persistent nonresectable disease is loc...
...The evidence is insufficient to rec...
...4. Patients with xerostomia are at i...
...correction should be considered for nasol...
...Although patients should be counseled on the ri...
...7. Patients receiving therapeutic dose...
...Women of childbearing age receiving...
...Radioactive iodine should not be given to nursing...
...ceiving cumulative radioiodine activities >400...
...Radioiodine-refractory structurally-evident DT...
...with I refractory metastatic 131DTC that...
92. B) BRAF or other mutational tes...
...3. A) Both stereotactic radiation an...
...) Stereotactic radiation or thermal ablation...
...While surgical resection and stereotactic exter...
...hould be considered for referral to particip...
.... A) Kinase inhibitor therapy should be consi...
...ents who are candidates for kinase...
...7. Patients who have disease progression while...
98. Active surveillance: Proactive monitoring and...
...out established efficacy in DTC sh...
...00. Cytotoxic chemotherapy can be considered in R...
...osphonate or denosumab therapy should be consid...
...Factors to Review When Considering Kinase In...
...tial Toxicities and Recommended Scr...