Table 3 Simplified lowiodine diet typically used for 1014 days prior to radioiodine scanning or therapy for thyroid cancer

The Natural Thyroid Diet

The Natural Thyroid Diet

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These are high iodine foods and should be avoided.

Table salt or sea salt (do NOT use salt in food preparation or at the table) All fish, sea food and shellfish

Potato chips, pizza, salted nuts and other heavily salted foods Tea and instant coffee

Canned soups, canned vegetables/fruits and canned vegetable juices (unless unsalted)

Milk and other dairy products (see below) Eggs (maximum one per day) (see below)

Foods or beverages containing red food coloring, chocolate or molasses Some medicines (multiple vitamins, Buckley's mixture, cod liver oil, amiodarone)

Restaurant preparation techniques and ingredients are usually unknown, and should probably be avoided as well.

No other foods need to be restricted.

Foods that contain small amounts of eggs or milk can be used

Unsalted meats, fresh fruits and vegetables, breads, cereals, pasts and unsalted french fries can also be used such as AGES (Age, Grade, Metastasis and Size) and TNM (Tumor, Node, Metastasis). There is no universal agreement about which scheme is preferable. Clinical validation for the AMES variables has come from follow up of large series, with recurrence rates ranging from 6.8% in stage I to 50% in stage IV (Mazzaferri criteria). For purposes of illustration, the AMES criteria will be discussed here.

A Adults older than 45 years of age tend to have disease with more aggressive behaviour. Older patients should all be considered to be at increased risk of recurrence, regardless of tumor characteristics.

M The most common sites of metastases from papillary carcinoma are the regional lymph nodes and the lungs. The presence of lymph node involvement of itself has little effect on the prognosis as these are usually easy to treat by resection and RAI. However, bilateral neck or mediastinal lymph node disease may adversely affect the prognosis. Lung metastases signal a high risk for disease persistence/recurrence. Hematogenous dissemination occurs rarely, typically to bone and brain, and is associated with a grim prognosis. Follicular carcinoma, on the other hand, tends to metastasize via the hematogenous route with involvement of bones, lungs, brain and other viscera, yet metastatic disease may be compatible with prolonged survival.

Accurate preoperative detection of distant metastases is typically not possible with these cancers underscoring the importance of RAI imaging to detect extent of metastatic disease and the difficulty inherent in imaging them while the thyroid gland is in place. Thus, the definitive discussion of prognosis must often await ablation of remnants with RAI and post-therapy scanning.

E The local extent of disease includes consideration of extrathyroidal extension of tumor into adjacent tissues, vascular invasion, the finding of tumor at the resection

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