NCCN Guidelines for Patients
Thyroid Cancer, Version 1.2017
Papillary, follicular, and
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