Treatment of Follicular Thyroid Cancer with Distant Metastases
This protocol addresses the management of follicular thyroid cancer in patients presenting with distant metastatic disease, where the choice and sequence of systemic intervention is guided by tumour avidity and response characteristics.
Clinical Scenario
Follicular thyroid carcinoma with documented distant metastases. The extent and functional characteristics of the metastatic deposits determine the treatment pathway and the schedule of intervention in this setting.
Treatment Approach (partial overview)
The protocol centres on radioiodine-based therapy administered following appropriate hormonal stimulation, with the schedule and continuation of therapy dependent on metastatic avidity. Thyroid hormone suppression is maintained between treatment cycles.
Full regimen details, dosing schedule, and decision algorithm → see protocol below
References
- Patients with distant metastases should receive 100–200 mCi (3.7–7.4 GBq) of 131I after TSH stimulation [IV, A].
- If the distant metastases are RAI-avid, 131I is administered every 6 months for 2 years and less frequently thereafter.
- Between treatments, suppressive doses of levothyroxine are given to maintain serum TSH levels below 0.1 mIU/ml (unless there are specific contraindications) [III, B].
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