Thyroid Disorders Testing Algorithm - ARUP Consult

Abbreviations CEA Carcinoembryonic antigen FNA Fine needle aspiration MTC Medullary thyroid cancer PTC Papillary thyroid cancer

Thyroid Cancer Testing

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INDICATIONS FOR TESTING Thyroid nodule identified as indeterminate, malignant, or

suspicious for malignancy by FNA

PERFORM Histologic analysis of resected nodule or core biopsy specimen

CONSIDER Molecular testing (RECOMMENDED for indeterminate nodules)

PTC

CONSIDER Testing for familial adenomatous polyposis

in patients with cribriform-morular variant

of PTC

Folliclular thyroid cancer

CONSIDER Testing for PTEN

hamartoma syndrome

H?rthle cell cancer

Noninvasive follicular thyroid neoplasm with papillarylike

nuclear features

Poorly differentiated thyroid cancer

Anaplastic thyroid cancer

MTC

Poor prognosis

CONSIDER Personalized treatment

based on actionable mutations

ORDER Calcitonin

Calcitonin elevated

CONSIDER Surgery

See Thyroid Cancer Monitoring and Surveillance algorithm for cancers treated with total thyroidectomy

and radioactive iodine ablation

MTC confirmed

ORDER Calcitonin stimulation test

REPEAT Calcitonin

Elevated calcitonin confirmeda

Treatment with RET inhibitors planned

ORDER RET germline genetic testing

CONSIDER Treatment

ORDER Testing for somatic

RET mutations

aCEA is also expressed in MTC, but not in other primary thyroid cancers, so CEA testing may be useful if calcitonin-negative MTC is suspected. Results should be interpreted with care, as elevated CEA is associated with other malignancies, and coexisting CEA-expressing tumors and metastases should be ruled out, especially in cases of otherwise undetectable residual disease.

Surgical treatment planned

Evaluate for pheochromocytoma and

hyperparathyroidism

Surgical treatment performed

References ? Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical

guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract. 2016;22(5):622-39. PubMed ? Haugen BR, Alexander EK, Bible KC, et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.

Thyroid. 2016; 26(1): 1-133. PubMed ? NCCN Clinical Practice Guidelines in Oncology, Thyroid carcinoma. National Comprehensive Cancer Network. Fort Washington, PA. V2.2019 [Updated: Sept 2019;

Accessed: Jun 2020]

ORDER Calcitonin and Carcinoembryonic Antigen at least

4 times over 2 years

? 2006 ARUP Laboratories. All Rights Reserved.

Content reviewed: June 2020

Last updated: June 2020

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