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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Treatment guide

Papillary, follicular, and

Hürthle cell

When the thyroid cancer takes up (eats) radioiodine,

RAI therapy will be considered for treatment.


Guides 13 and 14

on pages 46 to 48


If there is

no uptake, a different treatment will be considered.

Tests will be done before treatment. This might

include imaging (ultrasound or 123I imaging) and

blood tests (Tg and anti-Tg antibodies), or even an

FNA if there are lymph nodes that may be cancer.

From there you may have further surgery, start

levothyroxine to control TSH, or consider RAI therapy


If it is recommended or may be recommended that

you have RAI therapy, you will start RAI after your

imaging test. If not completely seen but there is

concern for cancer spread, you may get smaller

doses for a small area of cancer. Your doctor may

also consider different doses of RAI therapy based

on the extent of disease. The dose would increase

for metastatic disease that has spread to other areas.

The dose of RAI therapy is also adjusted for children

with thyroid cancer and people on dialysis for kidney

disease. For some patients, rhTSH (






) may be given before RAI therapy.

rhTSH is given to help with iodine uptake so people

can continue to take levothyroxine during RAI

therapy. If any cancer can be removed by surgery,

this should be considered before starting RAI