Management of patients with differentiated thyroid cancer who have positive serum thyroglobulin levels and negative radioiodine scans.

Most current evidence suggests that patients with papillary or follicular thyroid cancer after total thyroidectomy who are Tg positive (Tg > or = 10 ng/mL) and radioactive iodine scan negative warrant treatment with 100 mCi of 131I with a follow up scan and Tg determination. If isolated focal metastatic deposits are present they should be resected before treatment with radioiodine. Although some physicians might recommend radioiodine treatment only for high risk patients, we would recommend it for all patients with elevated serum Tg levels that increase after TSH stimulation, or until further information becomes available to support a different approach.