علاج سرطان الغدة الدرقية الحليمي >4 سم، مع الامتداد خارج الغدة الدرقية، أو المرض النقيلي (cT3a أو cT3b أو cT4 أو cN1 أو cM1)

References

DOI: 10.1177/10507256251363120

• For patients with thyroid cancer >4 cm (cT3a), cancer of any size with gross extra-thyroidal extension (cT3b or cT4), or clinically apparent metastatic disease to lymph nodes (cN1) or distant sites (cM1), the initial surgical procedure should include a total thyroidectomy with gross removal of all primary tumor and node dissection unless there are contraindications to this procedure.
• RAI adjuvant therapy is recommended routinely after total thyroidectomy for patients with ATA high-risk DTC.
• In patients with an initial diagnosis of DTC with distant metastases, RAI therapy is recommended routinely after total thyroidectomy.
• In patients with DTC in whom RAI remnant ablation or adjuvant therapy is planned, preparation with rhTSH stimulation is preferred over thyroid hormone withdrawal.
• A goal of TSH >30 mIU/L should be employed in preparation for RAI therapy or diagnostic testing.
• A meaningful response to RAI is generally a significant reduction in serum Tg level and/or the size (or rate of growth) of structurally apparent disease.