American Thyroid Association Response to Therapy Classification in Thyroid Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Excellent Response to Therapy:
    • Patients with no biochemical (unstimulated serum thyroglobulin (Tg) < 0.2 or stimulated Tg < 1.0 ng/mL) or radiographic evidence of disease are classified as having an excellent response to therapy
    • Patients with an initial low to intermediate risk of recurrence who meet these criteria:
      • Are recommended to have serum Tg monitored every 12 to 24 months
    • Patients with initially high-risk disease:
      • Should continue to have a serum Tg measurement at least every 6 to 12 months
  • Biochemical Incomplete Response to Therapy:
    • Patients who have undergone total thyroidectomy and remnant ablation and have an unstimulated serum Tg > 1 ng/mL or a stimulated Tg > 10 ng/mL or a rising thyroglobulin antibody (TgAb) titer with negative imaging:
      • Are classified as having a biochemical incomplete response to therapy
    • Such patients should undergo imaging with sonography of the neck:
      • If the disease is unable to be located:
        • Cross-sectional imaging of the neck and chest should be performed
    • Serum Tg should be followed at least every 6 to 12 months.
  • Structural Incomplete Response to Therapy:
    • Those patients with structurally or functionally (on diagnostic whole-body scan [DxWBS] or 18(FDG-PET) evident disease are classified as:
      • Having a structural incomplete response to therapy
    • Unfortunately, the majority of patients in this category will have persistent disease in spite of additional treatments
    • Disease-specific death rates are high in this group:
      • 11% with locoregional metastases
      • 50% with distant metastases
  • Indeterminate Response to Therapy:
    • Patients with biochemical or structural findings that cannot be confidently classified as either excellent response or persistent disease:
      • Are deemed as having an indeterminate response to therapy
    • Such patients may be carefully followed with biochemical testing and serial imaging to better delineate which category is ultimately appropriate
    • It is estimated that up to 20% of these patients will eventually develop conclusive evidence of disease requiring additional therapy
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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