Treatment/Prognosis Flashcards
Generally, what is the Tx paradigm for TCa?
DTCa Tx paradigm: primary Sg (even in M1 Dz) → observation vs. adj Tx
What are the 3 surgical options in TCa?
Surgical options in TCa are:
Lobectomy + isthmusectomy
Near-total thyroidectomy
Total thyroidectomy
What is the difference b/t near-total and total thyroidectomy?
Near-total is less aggressive around the recurrent laryngeal nerve.
For which pts with papillary TCa is a lobectomy + isthmusectomy adequate?
Controversial. It is a good option for pts with none of the following risk factors: age >55 yrs, tumor >4 cm, aggressive histology variant, prior Hx of RT, N+, extrathyroid extension.
In addition to improved LC, what is another reason to advocate for a total thyroidectomy even in low-risk pts?
It allows for easier f/u with whole-body iodide scans and serum thyroglobulin (Tg).
Per NCCN guidelines (2018), what are 3 indications for recommending adj Tx after GTR in DTCa?
Indications for adj Tx after GTR in DTCa are (if any present):
> 4-cm tumor
Extrathyroidal extension
Postop unstimulated Tg >5–10 ng/mL
What are the 5 aggressive histologic subtypes of DTCa that merit consideration of adj Tx?
Aggressive histologic subtypes that merit consideration of adj Tx are:
Tall cell
Columnar cell
Hobnail
Poorly differentiated
Generally, what is the adj Tx paradigm for DTCa?
DTCa adj Tx paradigm: long-term TSH suppression alone or with I-131 +/- EBRT
What are the indications for adj I-131 in addition to TSH suppression for DTCa?
Suspected or proven residual normal thyroid tissue or residual tumor, are indications for adj I-131.
What is the mCi dose range to ablate residual normal thyroid tissue?
30 mCi is as effective as 100 mCi to ablate residual normal thyroid tissue in low-risk DTCa. (Mallick U et al., NEJM 2012)
