Sandbox: wdx

Do's

Thyroglobulin level monitoring

Order serum thyroglobulin periodically during follow-up of patients with differentiated thyroid cancer who have undergone less than total thyroidectomy
Order serum thyroglobulin periodically during follow-up of patients with differentiated thyroid cancer who have had a total thyroidectomy but not radioactive iodine ablation

Cervical ultrasound

18FDG-PET scanning

Consider 18FDG-PET scanning in high-risk differentiated thyroid cancer patients with elevated serum thyroglobulin (generally >10 ng/mL) and negative radioactive iodine imaging

CT scans

Order chest CT scan with or without intravenous contrast in high-risk differentiated thyroid cancer patients with elevated serum thyroglobulin (generally >10 ng/mL) or rising thyroglobulin 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 radioactive iodine and/or external beam radiation therapy (EBRT) in patients with aerodigestive invasive disease
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 and every 6-12 months