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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2016


Treatment guide

Papillary, follicular, and

Hürthle cell

Guide 15. After treatment, surveillance and maintenance for papillary, follicular,

or Hürthle cell

Surveillance and maintenance

• Physical exam

• TSH and Tg measurement (plus anti-Tg antibodies) at 6 and 12 months, then yearly if disease free

• Ultrasound of the neck

* For low-risk patients, only done if concern cancer will come back (recur)

• TSH stimulated (check TSH level off of thyroid medication) radioiodine imaging for:

• High-risk patients

• Prior RAI therapy that worked for metastatic disease

• Abnormal Tg levels

• Stable or rising anti-Tg antibodies

• Abnormal ultrasound results

Guide 16. Testing results during surveillance and maintenance for papillary,

follicular, or Hürthle cell

Test results

Next steps of care

No disease found

• Long-term surveillance with unstimulated Tg (continuing thyroid medication during

testing) done yearly and routine neck ultrasound for:

• Prior RAI therapy and a negative ultrasound

• Stimulated Tg less than 2 ng/mL with negative anti-Tg antibodies

• Negative results on RAI imaging (if done)

• TSH-stimulated testing or other imaging tests may be done if there is a concern the

cancer will come back (recurrence)

Abnormal results

• More testing if:

• RAI uptake is present with the Tg level found, or distant metastases, or cancer in soft

tissue (found on tests used to stage the cancer)—get radioiodine imaging every 12

to 24 months until RAI therapy is no longer working

• Radioiodine imaging is negative and Tg is less than 2 to 5 ng/mL—consider other

imaging tests like ultrasound, neck CT, or chest CT