Download Post-treatment scan result

Thyroid Multidisciplinary Team Meeting – 4 July 2012
Name:
DOB:
MRN:
Consultant:
Diagnosis
Reason for
Review
Is input from Medical Oncologist required?
INITIAL PRESENTATION
Presentation
Risk factors: XRT
FHx
SHx
Initial U/S
Initial FNA
SURGICAL MANAGEMENT
Date:
Surgeon:
Yes / No
Comorbidities:
Procedure:
Finding:
HISTOLOGY
Type
Max diam
Lymph
nodes
Invasion
RADIOIODINE REMNANT ABLATION
Date
Dose
Post-treatment scan result
Stimulation
Tg
TgAb
TSH
FOLLOW UP
Date
Event (Ix/Rx)
Stimulation
Tg
TgAb
TSH
Result
SUMMARY & RECOMMENDATIONS
Summary:
Recommendation:
Further Instructions for Data Collection
FNA needs to say which side or nodule was sampled every time
Measurements should all be in mm, not cm
RAI should be reported in mCi, not Mbq
Method of stimulation can be abbreviated as T4WD or rh-TSH for T4 withdrawal or
human recombinant TSH, respectively
PLEASE USE THE FOLLOWING STANDARD ABBREVIATONS
Stim Tg
stimulated thyroglobulin
Unstim Tg
unstimulated thyroglobulin
TgAb
thyroglobulin antibody
T4wd
thyroid hormone withdrawal
RhTSH recombinant human TSH (thyrogen)
DxWBS diagnostic (low dose) radioiodine whole body scan
TxWBS post-treatment (high dose) radioiodine whole body scan
PTC
papillary thyroid cancer
PTCfv
papillary thyroid cancer, follicular variant
FTC
follicular thyroid cancer
MTC
medullary thyroid cancer
CLND
central lymph node dissection
CURRENT TNM STAGING (AJCC 6th ed)
T1
<2cm
T2
2-4cm
T3
>4cm or minimal extratrathyroidal invasion
T4a
gross extathyroidal invasion
T4b into prevertebral fascia, encasing carotid or medst vessels
N1a
N1b
level VI nodes
any other nodes
Stage <45yo
I
M0
II
M1
III
IVa
IVb
>45yo
T1, N0
T2, N0
T3, N0
T1-3, N1a
T1-3, N1b
T4a, any N
T4b, any N
IVc
M1