Sandbox: wdx: Difference between revisions
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== Do's == | |||
'''Thyroglobulin level monitoring''' | |||
*Order serum Tg periodically during follow-up of patients with differentiated thyroid cancer who have undergone less than total thyroidectomy | |||
*Order serum Tg periodically during follow-up of patients with differentiated thyroid cancer who have had a total thyroidectomy but not radioactive iodine ablation | |||
'''Cervical ultrasound''' | |||
*Perform cervical ultrasound to evaluate thyroid 6–12 months following surgery | |||
'''18FDG-PET scanning''' | |||
*Consider 18FDG-PET scanning in high-risk differentiated thyroid cancer patients with elevated serum Tg (generally >10 ng/mL) and negative radioactive iodine imaging | |||
'''CT scans''' | |||
*Order chest CT scan with or without IV contrast in high-risk differentiated thyroid cancer patients with elevated serum Tg (generally >10 ng/mL) or rising Tg antibodies with or without negative radioactive iodine imaging | |||
'''TSH range''' | |||
*Maintain serum TSH below 0.1 mU/L in patients with a structural incomplete response to therapy, indefinitely in the absence of specific contraindications | |||
*Maintain serum TSH between 0.5-2 mU/L in patients with an excellent or indeterminate response to therapy, especially those at low risk for recurrence | |||
'''Surgery for nodal disease''' | |||
*Perform surgery in patients with clinically apparent, macroscopic nodal disease | |||
*Perform therapeutic compartmental central and/or lateral neck dissection in a previously operated compartment, in patients with biopsy-proven persistent or recurrent disease for central neck nodes ≥8 mm and lateral neck nodes ≥10 mm | |||
*Perform compartmental surgery | |||
*Perform combination of surgery and RAI and/or EBRT in patients with aerodigestive invasive disease | |||
*Perform combination of surgery and 131I and/or external beam radiation therapy in patients who have tumors that invade the upper aerodigestive tract | |||
*Order complete blood count and assessment of renal function before administration of radioactive iodine | |||
*Discuss preventive strategies for dental caries with patients with xerostomia | |||
'''Radioactive iodine therapy''' | |||
*Order pregnancy test before radioactive iodine administration | |||
*Administer radioactive iodine therapy in patients with iodine-avid bone metastases | |||
*Administer radioactive iodine therapy in patients with pulmonary micrometastases | |||
*Repeat radioactive iodine therapy in patients with pulmonary micrometastases every 6-12 months | |||
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Revision as of 20:39, 20 November 2017
Do's
Thyroglobulin level monitoring
- Order serum Tg periodically during follow-up of patients with differentiated thyroid cancer who have undergone less than total thyroidectomy
- Order serum Tg periodically during follow-up of patients with differentiated thyroid cancer who have had a total thyroidectomy but not radioactive iodine ablation
Cervical ultrasound
- Perform cervical ultrasound to evaluate thyroid 6–12 months following surgery
18FDG-PET scanning
- Consider 18FDG-PET scanning in high-risk differentiated thyroid cancer patients with elevated serum Tg (generally >10 ng/mL) and negative radioactive iodine imaging
CT scans
- Order chest CT scan with or without IV contrast in high-risk differentiated thyroid cancer patients with elevated serum Tg (generally >10 ng/mL) or rising Tg antibodies with or without negative radioactive iodine imaging
TSH range
- Maintain serum TSH below 0.1 mU/L in patients with a structural incomplete response to therapy, indefinitely in the absence of specific contraindications
- Maintain serum TSH between 0.5-2 mU/L in patients with an excellent or indeterminate response to therapy, especially those at low risk for recurrence
Surgery for nodal disease
- Perform surgery in patients with clinically apparent, macroscopic nodal disease
- Perform therapeutic compartmental central and/or lateral neck dissection in a previously operated compartment, in patients with biopsy-proven persistent or recurrent disease for central neck nodes ≥8 mm and lateral neck nodes ≥10 mm
- Perform compartmental surgery
- Perform combination of surgery and RAI and/or EBRT in patients with aerodigestive invasive disease
- Perform combination of surgery and 131I and/or external beam radiation therapy in patients who have tumors that invade the upper aerodigestive tract
- Order complete blood count and assessment of renal function before administration of radioactive iodine
- Discuss preventive strategies for dental caries with patients with xerostomia
Radioactive iodine therapy
- Order pregnancy test before radioactive iodine administration
- Administer radioactive iodine therapy in patients with iodine-avid bone metastases
- Administer radioactive iodine therapy in patients with pulmonary micrometastases
- Repeat radioactive iodine therapy in patients with pulmonary micrometastases every 6-12 months