Is there survival benefit from life-long follow-up after treatment for differentiated thyroid cancer?

A best evidence topic was written according to a structured protocol. The question addressed was whether there is a survival benefit from life-long follow-up after treatment for thyroid cancer. A total of 137 papers were identified using the reported searches of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The existing guidelines for follow-up in thyroid cancer recommend life-long follow-up as recurrence may present after 5 years. However, the strategy of life-long follow-up for everyone (as advised by the British, European and American Thyroid Association guidelines) is not evidence-based. The issue is that some of the recurrences may present after 5 years and low volume recurrence may be more effectively treated. However, as in many other malignancies, there is no study that reliably shows a survival benefit conferred from life-long follow-up, especially in stage 1 disease. Moreover, the risk of recurrence only parallels the risk of disease-specific mortality in the older thyroid cancer patient group (>45 years at diagnosis). The evidence from the present review supports a risk stratified approach to follow-up for thyroid cancer since low-risk thyroid cancer is associated with low recurrence rates and mortality compared to the other groups. For young patients (<45 years at diagnosis) with stage 1 disease, there is no proven survival benefit from life-long follow-up following primary treatment. These patients could be safely discharged to primary care after 5 years for follow-up with yearly thyroglobulin measurements.