Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective.
OBJECTIVE
Because differentiated (follicular and papillary) thyroid cancer (DTC) may recur years after initial treatment, the follow-up of patients with DTC is long term. However, this population has changed, with more individuals being discovered at an earlier stage of the disease, so that previous follow-up protocols based mostly on data from high-risk patients no longer apply. We sought to develop an improved protocol for the follow-up of low-risk patients with DTC based on the findings of recent studies.


METHODS
We analysed recent literature on the follow-up of DTC.


RESULTS
Recent large studies have produced three important findings: (i) in patients with low-risk DTC with no evidence of disease up to the 6- to 12-month follow-up, diagnostic whole-body scan adds no information when serum thyroglobulin (Tg) is undetectable and interference from anti-Tg antibodies is absent; (ii) use of recombinant human thyroid-stimulating hormone to aid Tg measurement is effective and provides greater safety, quality-of-life and work productivity than does levothyroxine withdrawal with its attendant hypothyroidism; and (iii) ultrasonography performed by an experienced operator is the most sensitive means of detecting neck recurrences of DTC.


CONCLUSIONS
We present a revised follow-up protocol for low-risk patients taking into account the above findings. This protocol should help clinicians enter a new era of monitoring characterized by greater safety, simplicity, convenience and cost savings.
Schlumberger
Martin
M
Institut Gustave Roussy, Villejuif, France. schlumbg@igr.fr
Berg
Gertrud
G
Cohen
Ohad
O
Duntas
Leonidas
L
Jamar
François
F
Jarzab
Barbara
B
Limbert
Eduard
E
Lind
Peter
P
Pacini
Furio
F
Reiners
Christoph
C
Sánchez Franco
Franco
F
Toft
Anthony
A
Wiersinga
Wilmar M
WM
D018263:Adenocarcinoma, Follicular / Q000097:blood / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D002291:Carcinoma, Papillary / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D002985:Clinical Protocols / Q000592:standards; D003663:Decision Trees; D005060:Europe; D005500:Follow-Up Studies; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins; D012306:Risk; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography
D011994:Recombinant Proteins; D013954:Thyroglobulin