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Post Operative Investigation of Thyroid Carcinoma

Patient age <40 yrs and non-invasive papillary or follicular carcinoma less than 3 cm

  • Subtotal thyroidectomy
  • Ablation dose 131I, day 5 post-operatively, 2 hours after i.v. TRH
  • Replacement therapy (T4) started 3 days post ablation, and increased to 200 mcg daily.
  • Follow-up, with TSH and thyroglobulin levels.
  • 131I scan only if recurrence suspected clinically.

Extrathyroidal papillary carcinoma, non-invasive papillary carcinoma if age > 40 yrs or follicular carcinoma

  • Subtotal thyroidectomy
  • Ablation dose 131I
  • Replacement therapy (T3) started 3 days post ablation, and increased to 20 mcg twice daily
  • Regular follow-up with 131I scanning (3 and 6 months, and then at years 1, 2, 3, 5 and 7)
    · If no evidence of recurrence after 2nd 131I scan, switch to T4 suppression (200mcg daily).
  • T3 needs to be discontinued 8 days prior to 131I scan and TSH measured on day of scan to ensure appropriate interpretation.