Thyroid nodule secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Thyroid Nodule Secondary Prevention

Secondary prevention of a thyroid nodule is aimed at the prevention of recurrence after removal of a primary nodule (specially in case of malignant lesions). The following steps outline the secondary prevention of malignant thyroid nodules:

1. Routine screening for disease recurrence

• Measurement of serum thyroglobulin levels after total thyroidectomy.
• Post-op diagnostic RAI scanning
• Post-op ultrasound

2. Serum TSH goals

• Maintain TSH levels between:
  • Non-stimulated thyroglobulin < 0.2 ng/ml : TSH should be 0.5-2.0 mU/L
  • Non-stimulated thyroglobulin greater than equal to 0.2 ng/ml: TSH should be 0.1-0.5 mU/L

3. Evaluation of response to therapy

• Serum thyroglobulin levels
• Neck ultrasound
• Whole body scanning (not routinely indicated)

4a. Excellent response to therapy

• Primary follow-up with clinical exam and non-stimulated thyroglobulin levels (TSH goal 0.5-2 mU/L)
• Non-stimulated thyroglobulin levels at 12-24 month intervals
• Periodic neck ultrasound