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

• 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

Don'ts

• Do not administer radioactive iodine to pregnant women
• Do not administer radioactive iodine to nursing women
• Do not perform surgery with focal “berry-picking” techniques