LAUSR

The treatment paradigm for thyroid cancer has shifted from a one-size-fits-all approach to more personalized protocols that range from active surveillance to total thyroidectomy followed by radioiodine remnant ablation. Accurate surveillance tools are available, but follow-up protocols vary widely between centres and clinicians, owing to the lack of clear, straightforward recommendations on the instruments and assessment schedule that health-care professionals should adopt. For most patients (that is, those who have had an excellent response to the initial treatment and have a low or intermediate risk of tumour recurrence), an infrequent assessment schedule is sufficient (such as a yearly determination of serum levels of TSH and thyroglobulin). Select patients will benefit from second-line imaging and more frequent assessments. This Review discusses the strengths and weaknesses of the surveillance tools and follow-up strategies that clinicians use as a function of the initial treatment and each patient’s risk of recurrence.Treatment protocols for thyroid cancers range from active surveillance to total thyroidectomy followed by radioiodine remnant ablation. In this Review, the authors discuss the strengths and weaknesses of the surveillance tools and follow-up strategies used by clinicians in the treatment of thyroid cancers.Key pointsThyroid cancer follow-up varies according to the histotype, the initial treatment, the initial risk of recurrence and the response to treatment.An excellent response to the initial treatment is defined by an undetectable serum thyroglobulin in the absence of thyroglobulin antibody and the absence of abnormal findings on neck ultrasonography.Patients with a low or intermediate risk of disease recurrence who have an excellent response to treatment can be followed up with yearly serum TSH, thyroglobulin and anti-thyroglobulin antibody determination.When serum levels of thyroglobulin (or anti-thyroglobulin antibody titre) have a rising trend with time, ultrasonographic, cross-sectional or functional imaging should be considered according to the patient’s risk and local resources.Patients with a high risk of disease recurrence who do not respond excellently to treatment should be followed up with serum TSH, thyroglobulin and anti-thyroglobulin antibody determination and neck ultrasonography every 6–12 months.When untreated, structural disease should be followed up with periodic imaging, with the frequency and the imaging tools depending on disease burden, location and pace of disease progression.