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45

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

Guide 12. Observe or further treatment after surgery for papillary, follicular, or

Hürthle cell

Remaining disease

Next steps of care

Surgery

ª

• No

remaining

disease

ª

• Consider RAI

therapy after

thyroidectomy

• Remaining

disease

Follow the arrows below

Not able to

have surgery

ª

• TSH and Tg

(plus anti-Tg

antibodies)

measured 6

to 12 weeks

after surgery

• Consider

whole body

radioiodine

imaging

ª

• Not enough

RAI uptake

on imaging

scan

ª

• Observe

or

• Consider

radiation

(EBRT/IMRT)

ª

• Enough

RAI uptake

on imaging

scan

ª

• Radioiodine

treatment

(preferred)

• 131I imaging

after treatment

• Consider

radiation

(EBRT/IMRT)

ª

• No RAI

imaging

done

• If no disease after first surgery, go right to considering RAI therapy

• After radioiodine treatment, 131I imaging, or EBRT/IMRT consider levothyroxine to suppress TSH

Guide 12

shares further testing or treatment after

surgery. Your doctor will check for any remaining

disease. If there is no disease, your treatment may

be RAI therapy. If you can’t have surgery or there is

disease remaining, you may have your TSH, Tg, and

anti-Tg antibody level measured. You may also have

a whole body radioiodine imaging test to see if any

cancer cells remain. The results of these tests will

determine if you move forward with more treatment

or your doctor watches you closely for cancer growth

(observes you).

5

Treatment guide

Papillary, follicular, and

Hürthle cell