Figure 3.

Flowchart of follow-up of children with DTC having received complete remission after initial treatment with total thyroidectomy and I-131. This flowchart is developed for children with DTC having received complete remission defined as: undetectable levels of serum Tg on LT4, undetectable levels of Tg antibodies, negative neck ultrasound, and if performed, negative whole-body scan 1 year after last treatment. ^{^}In the first year until clinical remission, TSH levels should be suppressed, while a normal low value of TSH (between 0.5 and 1.0 mU/L) will be advisable thereafter. ^{^^}The definition of consistent rising Tg on LT4 is debatable; the levels of Tg as well as the doubling time should be taken into account and weighted in the individual patient. ^*The expert panel suggests that, in children with detectable (but not rising) Tg and no focus on neck ultrasound, in individual cases, I-123 scanning may be considered. When both ultrasound and radioiodine imaging did not yield a focus, FDG PET/CT may be considered.