Follow-up in Differentiated Thyroid Cancers Under 1cm

Question

I am very impressed by WWW.THYROIDMANAGER.ORG and wish there were more like this. I have a question about the treatment and f/u of incidental or minimal pap thyroid cancer. Do you have any literature sources you could recommend reading re: this common problem? As an example, I have a 47 yo female patient with a 3mm. pap found incidentally, who underwent a near total thryoidectomy. My questions are: 1. Would you recommend rx with I131 remnant ablation? 2. If not, how would you follow this pt for recurrence? (Serial TG's? TG 10 during thyroid hormone tx.as indic. for further eval?) 3. In general, is lobectomy sufficient for treatment if no significant nodules in opposite lobe? If so, how do you follow these pts for recurrence?

Thank you for your advice, Best regards,

Lisa Wisniewski, MD

Response

I believe that the general recommendation for post-op follow-up in a patient with what is effectively an incidentally discovered papillary or follicular cancer under 1 cm and under age 45, would be that no further surgery or RAI was needed, assuming that the rest of the gland was entirely normal. Further management should include T4 replacement, and serial physical exams, TGs, and ultrasounds at 1-2 year intervals. The TG response to TSH can not be fully informative if the thyroid remnant is in place. If there are nodules elsewhere in the gland, or multicentricity, or if the patient is >45 and the lesion is follicular, or if the pathology seems more invasive, traditional 131-I ablation and follow-up would be appropriate. I think you will find a reference or two in the section on Thyroid cancer in Thyroidmanager.

Best regards,

L De Groot,MD