Sandbox: wdx: Difference between revisions
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== Do's == | == Do's == | ||
'''Thyroglobulin level monitoring''' | '''Thyroglobulin level monitoring''' | ||
*Order serum | *Order serum [[thyroglobulin]] periodically during follow-up of patients with differentiated [[thyroid cancer]] who have undergone less than total [[thyroidectomy]] | ||
*Order serum | *Order serum [[thyroglobulin]] periodically during follow-up of patients with differentiated [[thyroid cancer]] who have had a total [[thyroidectomy]] but not [[Iodine-131|radioactive iodine]] ablation | ||
'''Cervical ultrasound''' | '''Cervical ultrasound''' | ||
*Perform | *Perform [[neck]] [[ultrasound]] to evaluate [[thyroid]] 6–12 months following surgery | ||
'''18FDG-PET scanning''' | '''18FDG-PET scanning''' | ||
*Consider 18FDG-PET scanning in high-risk differentiated thyroid cancer patients with elevated serum | *Consider 18FDG-PET scanning in high-risk differentiated [[thyroid cancer]] patients with elevated serum [[thyroglobulin]] (generally >10 ng/mL) and negative [[Iodine-131|radioactive iodine]] imaging | ||
'''CT scans''' | '''CT scans''' | ||
*Order chest CT scan with or without | *Order [[chest]] [[Computed tomography|CT scan]] with or without intravenous [[Contrast medium|contrast]] in high-risk differentiated [[thyroid cancer]] patients with elevated serum [[thyroglobulin]] (generally >10 ng/mL) or rising [[thyroglobulin]] [[antibodies]] with or without negative [[Iodine-131|radioactive iodine]] imaging | ||
'''TSH range''' | '''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 [[Thyroid-stimulating hormone|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 | *Maintain serum [[Thyroid-stimulating hormone|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''' | '''Surgery for nodal disease''' | ||
*Perform surgery in patients with clinically apparent, macroscopic 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 therapeutic compartmental central and/or lateral [[neck dissection]] in a previously operated [[Compartment (anatomy)|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 compartmental surgery | ||
*Perform combination of surgery and | *Perform combination of surgery and [[Iodine-131|radioactive iodine]] and/or [[External beam radiotherapy|external beam radiation therapy]] (EBRT) in patients with aerodigestive invasive disease | ||
*Order [[complete blood count]] and assessment of renal function before administration of [[Iodine-131|radioactive iodine]] | |||
*Order complete blood count and assessment of renal function before administration of radioactive iodine | *Discuss preventive strategies for [[dental caries]] with patients with [[xerostomia]] | ||
*Discuss preventive strategies for dental caries with patients with xerostomia | |||
'''Radioactive iodine therapy''' | '''Radioactive iodine therapy''' | ||
*Order pregnancy test before radioactive iodine administration | *Order [[pregnancy test]] before [[Iodine-131|radioactive iodine]] administration | ||
*Administer radioactive iodine therapy in patients with iodine-avid bone metastases | *Administer [[Iodine-131|radioactive iodine]] therapy in patients with iodine-avid [[bone metastases]] | ||
*Administer radioactive iodine therapy in patients with pulmonary micrometastases | *Administer [[Iodine-131|radioactive iodine]] therapy in patients with [[Lung|pulmonary]] micrometastases and every 6-12 months | ||
Revision as of 20:53, 20 November 2017
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
- Perform neck 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 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