FIG. 4.

Management of the pediatric patient with known distant metastases. ¹Assumes a negative TgAb (see Section D2); in TgAb-positive patients, the presence of TgAb alone cannot be interpreted as a sign of disease unless the titer is clearly rising; a declining TgAb titer would suggest continued response to treatment. ²Tg can transiently rise after ¹³¹I therapy and should not be misinterpreted as evidence for progression. ³Repeat ¹³¹I therapy in patients previously treated with high-dose ¹³¹I should be undertaken only if iodine-avid disease is suspected and if there was a previous response to therapy (see Section D7 and D8).