Refining long-term surveillance requirements in patients with differentiated thyroid cancer.

Abstract

Differentiated thyroid cancer (DTC) has an excellent long-term prognosis following treatment. Despite this, post-treatment surveillance may last several years with no defined end-point. The aim of our study was to identify patients at the lowest risk of recurrence and suitable for early discharge. We conducted a retrospective analysis of a single centre database of all patients undergoing surgery for DTC between 2009 and 2022. We excluded patients with distant metastasis or those without a Tg level two years after complete thyroidectomy. Patients were grouped into hemithyroidectomy (H), total thyroidectomy (TT) and total thyroidectomy with radioactive ablation (TTR). TT and TTR groups were risk stratified using the Tg level at 2-year into undetectable/low (UL) (Tg < 0.2), medium (M) (0.2-1.0) and high (H) (>1.0). The 2015 American Thyroid Association (ATA) risk stratification system was used to further subdivide these groups. 481 patients were included in the study. The overall structural recurrence rate was 19/481 (3.9%) over a median follow-up period of 64 months (1-164). All recurrences occurred in the TTR group, with a median time to recurrence of 21 months. A higher Tg at 2-year (P < 0.00001) and a high ATA risk 2015 score (P = 0.007) were associated with higher rate of recurrence. Based on ATA guidelines, 100 patients were identified as low risk in the UL group, and there were no recurrences during the follow-up period. Our study suggests that individuals managed with hemithyroidectomy alone or with undetectable/low Tg levels within 2-year of treatment may be suitable for early discharge.