Follow-up and transition of care for low recurrence risk thyroid cancer patients in Canada

Abstract

The incidence of differentiated thyroid cancer (DTC) has increased significantly in recent decades. Following initial diagnosis, DTC patients are classified according to the American Thyroid Association (ATA) as low, intermediate, and high risk for recurrence. Patients in the ATA low recurrence-risk category have a recurrence risk of ≤5%, with 20-year disease-specific mortality of <1%. Accordingly, there has been a shift to de-escalating initial treatment, including the relaxation of thyroid-stimulating hormone suppression. In addition, fewer low-risk patients undergo total thyroidectomy or radioactive iodine therapy. However, the optimal long-term surveillance strategy remains unclear, with many patients continuing follow-up in speciality clinics for many years. In addition, emerging evidence suggests that long-term surveillance can be effectively managed in primary care settings. To enhance understanding among Canadian thyroid practitioners and to improve care for Canadian patients diagnosed with low-risk DTC, we developed this consensus statement by collecting feedback from a multidisciplinary team led by one chairperson (endocrinologist), an additional eight endocrinologists, two surgeons, and one patient partner. This consensus statement reflects current evidence and expert opinion regarding initial management and long-term surveillance of low-risk DTC patients. This work is valuable to Canadian thyroid practitioners as it provides standardized guidelines to ensure optimal care and improved outcomes for low-risk DTC patients.

Keywords: differentiated thyroid cancer; follow-up; hemithyroidectomy; low risk of recurrence; radioactive iodine therapy; thyroid nodule; thyroid-stimulating hormone; total thyroidectomy.

Figure 1

Initial evaluation of response to therapy. (A) Is the response to therapy for total thyroid lobectomy, (B) is for total thyroidectomy with RAI, and (C) is for total thyroidectomy without RAI. Abbreviation: DTC, differentiated thyroid cancer; RAI, radioactive iodine therapy. Tg, thyroglobulin; US, ultrasound.

Figure 2

Schematic representation of patient selection and timing for transition of care of low-risk DTC patients. ATA, American Thyroid Association; Tg, thyroglobulin; TgAb, thyroglobulin antibody; TT, total thyroidectomy; RAI, radioactive iodine therapy; US, ultrasound.