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60

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

6

Treatment guide

Next steps of care

Guide 21. After treatment, surveillance for medullary

2 to 3 months after surgery Surveillance

Elevated

calcitonin or

elevated CEA

ª

• Neck

imaging

• If calcitonin

is 150

pg/mL do

contrast

CT or MRI

of neck,

chest, and

abdomen

and include

liver

ª

• Symptoms

or imaging

shows

disease

ª

• Seek care for recurrent or

persistent disease

ª

• No

symptoms

or imaging

shows no

disease

ª

• Serum (blood) calcitonin and

CEA every 6 to 12 months

• If needed, more or frequent

tests based on calcitonin

and CEA

• No imaging needed if

calcitonin and CEA are

stable

Calcitonin

and CEA are

within normal

range

ª

• Observe

ª

• Yearly calcitonin and CEA

• Consider ultrasound of the

front and sides of neck

• If needed, more or frequent

tests if rising calcitonin and

CEA

• No imaging needed if

calcitonin and CEA are

stable

• For MEN 2B or 2A, check

for pheochromocytoma and

hyperparathyroidism (MEN

2A)

Testing results during surveillance:

• Positive results - seek care for recurrent or persistent disease

• Negative results - continue observation, check for elevated basal calcitonin or elevated CEA, or consider

cervical surgery again (if primary surgery was incomplete)