Testing and Management

Although the long-term survival rate for patients diagnosed with well-differentiated thyroid cancer is generally quite good, tumor recurrence is common, affecting up to 30% of patients, sometimes even decades after initial therapy.^[1,2,3] These recurrences are often treatable, if detected early and managed appropriately. Despite the generally favorable prognosis for most well-differentiated thyroid cancer patients, there are still approximately 1,500 thyroid cancer deaths each year^[2] in the United States,^[4] about three-fourths of which are from well-differentiated thyroid cancer.^[5]

There is a well-documented higher risk of recurrent tumor associated with delay of primary diagnosis and treatment,^[1] and it is logical that delay in finding recurrent tumor is also likely associated with worse clinical outcome. It is critical that thyroid cancer patients undergo regular, lifelong monitoring. Routine follow-up procedures vary with patient age, extent of surgical resection, and primary tumor characteristics (size, histological type, extent of local invasion, and presence of metastatic disease or multifocality), as well as findings from clinical assessments such as ultrasound, chest x-ray, positron emission tomography (PET), computerized tomography (CT) scanning, and magnetic resonance imaging (MRI).

Generally, clinicians agree that neck ultrasound exams, serum thyroglobulin (Tg) and whole-body scans (WBS) testing are the most commonly used tests to monitor for thyroid cancer recurrences. Management guidelines published in 2006 by the American Thyroid Association provide an excellent summary.^[6] For more information on how Thyrogen® (recombinant human thyroid stimulating hormone [rhTSH]) can enhance the sensitivity and accuracy of follow-up testing, please visit the About Thyrogen section of this website.

REFERENCES:

1. Mazzaferri EL. An overview of the management of papillary and follicular thyroid carcinoma. Thyroid.1999; 9:421-427.

2. Schlumberger M et al. Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 150 (2):105-112, 2004.

3.Kloos R & Mazzaferri E. A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab 90: 5047-5057, 2005.

4. American Cancer Society. www.cancer.org. Accessed May 3, 2006.

5. Hundall SA, Fleming ID, Fremgen AM, Menck HR. 1998 A National Cancer Database report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995.

6. American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16 (2): 109-141, 2006. Download the ATA Guidelines here.