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46

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

5

Treatment guide

Papillary, follicular, and

Hürthle cell

Guide 13. Consider RAI therapy for papillary, follicular, or Hürthle cell

6 to 12 weeks after thyroidectomy

RAI therapy

Test results Further testing Next steps of care

Based on

pathology for

papillary, RAI

therapy may not

be recommended

ª

• Tg less than

1 ng/mL and

negative anti-Tg

antibodies

or

• Select patients,

with small

volume disease,

lower-risk

pathology, and

Tg less than

5-10 ng/mL

ª

• RAI therapy may not be

recommended

Based on

pathology for

follicular and

Hürthle cell, RAI

therapy may not

be recommended

ª

• Tg more than

5–10 ng/mL and

negative anti-Tg

antibodies

• No concern on

neck ultrasound

ª

• Consider

more

imaging of

the neck

and chest

CT

ª

• Consider

further

surgery

before

RAI

therapy

ª

• Consider

RAI

therapy/

adjuvant

therapy

• Tg less than

5–10 ng/mL and

negative anti-Tg

antibodies

• No concern on

neck ultrasound

ª

• Follow without RAI therapy

and

• See surveillance and

maintenance (Guides 15 and

16)

and

• Levothyroxine

ª

ª

• Concern for

cervical lymph

nodes on neck

ultrasound

ª

• No cancer

on FNA

ª

• Cancer on

FNA

ª

• Consider further surgery

before RAI therapy

ª