Differentiated Thyroid Cancer – ATA Low Risk for Recurrence Treated with Total Thyroidectomy +/- RAI

Discharge Criteria

Patients deemed to have low risk differentiated thyroid cancer with ATA defined excellent response to therapy at 2-5 years can be discharged with both of the following criteria met:

1. 1. No concerning sonographic findings on neck US (structurally complete response)
   2. American Thyroid Association (ATA) excellent biochemical response to therapy (low thyroglobulin [<0.2ng/ml] and negative thyroglobulin antibodies [assay dependent])

Suggest not to discharge if iatrogenic hypoparathyroidism post-operatively

Future Directions

• Differentiated thyroid ca treated with hemithyroidectomy
• Review new ATA guidelines 2024 (including USS f/u guidance depending on type of treatment given) 

Resources:

• Letter to primary care provider
• Letter to patient

Topic Expert Review: Anna Sawka, Afshan Zahedi  

Primary Care review: Dr Curtis Handford, DFCM, St Michael's Hospital 

Plain language review: Katrina Grieve, St Michael's Hospital 

References:  

1. Cancer Care Ontario. Differentiated Thyroid Cancer Treatment Pathway Map. Oct 2024 Update. https://www.cancercareontario.ca/en/pathway-maps/thyroid-cancer.  

2. Haugen et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020. PMID: 26462967; PMCID: PMC4739132.