Role of Postoperative Disease Status in Decision Making About RAI Therapy for Differentiated Thyroid Cancer (1)

Recommendation no.ATA guidance
50APostoperative disease status (i.e., the presence or absence of persistent disease) should be considered in deciding whether additional treatment (e.g., RAI, surgery, or other treatment) may be needed. (Strong recommendation, Low quality evidence)
50BPostoperative 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 thyroglobulin should reach its nadir by 3 to 4 weeks postoperatively in most patients (Strong recommendation, Moderate quality evidence)
50CThe optimal cutoff for postoperative 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. (No recommendation, Insufficient evidence)
50DPostoperative diagnostic radioactive iodine 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 radioactive iodine that is to be administered. Identification and localization of uptake foci may be enhanced by concomitant single photon emission computed tomography– computed tomography (SPECT/CT). When performed, pre-therapy diagnostic scan should utilize 123I (1.5 to 3 mCi) or a low activity of 131I (1 to 3 mCi) with the therapeutic activity optimally administered within 72 hours of the diagnostic activity. (Week recommendation, Low quality evidence)
  • 1 mCi = 37 MBq.