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52

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

5

Treatment guide

Papillary, follicular, and

Hürthle cell

Guides 17 and 18

focus on treatment for

disease that has spread to nearby or distant

areas, or disease that has come back (recurred).

Levothyroxine suppression of TSH is recommended

for Tg less than 10 ng/mL that can’t be removed. If

Tg is greater than 10 ng/mL but no disease is seen

on imaging, then RAI therapy is recommended. If

it is a local recurrence, then multiple options are

considered.

Your doctor would consider surgery (preferred),

radiation, RAI therapy, or another local therapy. This

other therapy might include treating the cancer with

ethanol (alcohol) or using radiofrequency waves that

generate heat to remove the cancer (radiofrequency

ablation).

Guide 17. Options for recurrent papillary, follicular, or Hürthle cell

Test results Next steps of care

• Stimulated Tg 1 to 10 ng/

mL

• Tumors that can’t be

removed

• Not able to get RAI

therapy

ª

• Consider levothyroxine

ª

• Continue surveillance

with unstimulated Tg test,

ultrasound, and other

imaging tests as needed

• Stimulated Tg more than

10 ng/mL

• Imaging tests are

negative (including PET)

ª

• Consider radioiodine therapy and 131I imaging after treatment

(more RAI should be given to those who responded to prior RAI

therapy)

• Local recurrence of

cancer

ª

• Surgery is preferred, if possible

and/or

• RAI therapy, if radioiodine imaging is positive

and/or

• Local therapy when available (eg, ethanol ablation or RFA

[

r

adio

f

requency

a

blation])

and/or

• Radiation (EBRT/IMRT), if radioiodine imaging is negative and no

response to other treatment