Consideration of Early Dynamic Risk Stratification to Guide Discharge from Oncologic Follow-Up in Patients with...

Area of Science:

• Endocrinology
• Oncology
• Nuclear Medicine

Background:

• Current practice involves lifelong follow-up for differentiated thyroid cancer (DTC) patients post-treatment.
• The optimal duration and intensity of follow-up require further investigation, particularly for patients with an excellent initial response.

Purpose of the Study:

• To determine the time to recurrence in DTC patients with an excellent response to therapy 6 months after total thyroidectomy and radioiodine treatment.
• To identify factors associated with recurrence and the time to suspicion of recurrence.

Main Methods:

• Retrospective cohort study of 492 DTC patients treated between 2008-2012.
• Remission defined by negative imaging and specific thyroglobulin (Tg) levels (suppressed Tg <0.2 ng/mL or recombinant human TSH-stimulated Tg <1 ng/mL) per 2015 ATA guidelines.
• Recurrence defined by metastatic disease or need for re-treatment.

Main Results:

• A total of 492 patients were included with a median follow-up of 7.9 years.
• Recurrence occurred in only 7 patients (1.4%), with all events happening within 10 years post-initial management.
• Suspicion of recurrence was detected within 8-10 years in most cases.

Conclusions:

• Differentiated thyroid cancer patients with low and intermediate risk, achieving remission 6 months post-treatment, exhibit an extremely low recurrence risk after 10 years.
• Consideration can be given to transitioning follow-up to primary care providers for these patients after a decade.
• Further prospective studies are recommended to confirm these findings and inform discharge recommendations.