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  • Review Article
  • Published:

Follow-up of differentiated thyroid cancer – what should (and what should not) be done

Nature Reviews Endocrinology volume 14, pages 538–551 (2018)Cite this article

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Abstract

The treatment paradigm for thyroid cancer has shifted from a one-size-fits-all approach to more personalized protocols that range from active surveillance to total thyroidectomy followed by radioiodine remnant ablation. Accurate surveillance tools are available, but follow-up protocols vary widely between centres and clinicians, owing to the lack of clear, straightforward recommendations on the instruments and assessment schedule that health-care professionals should adopt. For most patients (that is, those who have had an excellent response to the initial treatment and have a low or intermediate risk of tumour recurrence), an infrequent assessment schedule is sufficient (such as a yearly determination of serum levels of TSH and thyroglobulin). Select patients will benefit from second-line imaging and more frequent assessments. This Review discusses the strengths and weaknesses of the surveillance tools and follow-up strategies that clinicians use as a function of the initial treatment and each patient’s risk of recurrence.

Key points

  • Thyroid cancer follow-up varies according to the histotype, the initial treatment, the initial risk of recurrence and the response to treatment.

  • An excellent response to the initial treatment is defined by an undetectable serum thyroglobulin in the absence of thyroglobulin antibody and the absence of abnormal findings on neck ultrasonography.

  • Patients with a low or intermediate risk of disease recurrence who have an excellent response to treatment can be followed up with yearly serum TSH, thyroglobulin and anti-thyroglobulin antibody determination.

  • When serum levels of thyroglobulin (or anti-thyroglobulin antibody titre) have a rising trend with time, ultrasonographic, cross-sectional or functional imaging should be considered according to the patient’s risk and local resources.

  • Patients with a high risk of disease recurrence who do not respond excellently to treatment should be followed up with serum TSH, thyroglobulin and anti-thyroglobulin antibody determination and neck ultrasonography every 6–12 months.

  • When untreated, structural disease should be followed up with periodic imaging, with the frequency and the imaging tools depending on disease burden, location and pace of disease progression.

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Fig. 1: Follow-up protocols for patients with papillary thyroid cancer.

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Acknowledgements

L.L. and G.G. contributed to this paper as PhD students in the Biotechnology and Clinical Medicine programme of the University of Rome “Sapienza”. M.S. contributed to this paper as a recipient of the “Visiting professor for research activities 2016” grant (ID number C26V16RBXB) from the University of Rome “Sapienza”. The authors thank M. E. Kent for providing editorial support.

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Nature Reviews Endocrinology thanks S. Roman, A. Shaha, F. Verburg and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma “Sapienza”, Rome, Italy

    Livia Lamartina, Giorgio Grani, Cosimo Durante & Sebastiano Filetti

  2. Department of Biostatistic and Epidemiology, Gustave Roussy and University Paris-Saclay, Villejuif, France

    Isabelle Borget

  3. Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France

    Martin Schlumberger

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M.S., S.F., I.B. and C.D. provided substantial contributions to discussion of the content and reviewed and/or edited the manuscript before submission. L.L., I.B. and G.G. researched the data for the article and wrote the article.

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Correspondence to Martin Schlumberger.

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I.B., C.D., G.G., L.L. and S.F. declare no competing interests. M.S. has received research grants and honoraria from Sanofi-Genzyme.

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Lamartina, L., Grani, G., Durante, C. et al. Follow-up of differentiated thyroid cancer – what should (and what should not) be done. Nat Rev Endocrinol 14, 538–551 (2018). https://doi.org/10.1038/s41574-018-0068-3

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