Prospective Evaluation of Follow-Up De-Escalation to Primary Care in Differentiated Thyroid Cancer with Excellent Response to Therapy
Authors' conclusion
Our findings suggest that patients with DTC who complete ≥5 years of specialist follow-up and achieve ER may be safely transitioned to PC. ER represents a stable clinical state, with minimal risk of clinically meaningful recurrence even with markedly reduced biochemical and imaging surveillance.
Study context
- Population
- Patients with differentiated thyroid carcinoma (DTC) treated with total thyroidectomy ± radioiodine ablation, ≥5 years of specialist follow-up, discharged to primary care after excellent response (ER) (small subset with persistent indeterminate response (IR)); reassessed ≥5 years after discharge9 discharged with IR
- Participants
- 154 patients
- Outcome
- Biochemical or structural recurrence after discharge to primary care
- Follow-up
- Mean postdischarge 70.3 ± 10.6 months
Methodological detailsprospectively conducted postdischarge reassessment
- Prospectively conducted postdischarge reassessment
Main finding
As reported in the abstract
- No biochemical or structural recurrences
- All non-ER findings at reassessment occurred exclusively in patients already classified as IR at discharge, with no deterioration from ER
Observational data: associations, not effects.
Further findings
ER over time
- ER at 6 months
- 118/154 (76.6%)
- ER at predischarge
- 145/154 (94.2%)
- ER at postdischarge reassessment
- 148/154 (96.1%)
- Change in ER over time
- P < 0.001
IR over time
- IR at last predischarge visit
- 9/154 (5.8%)
- IR at postdischarge reassessment
- 6/154 (3.9%)
Baseline ATA-2025 recurrence risk
- Low
- 78/154 (50.6%)
- Intermediate-low
- 44/154 (28.6%)
- Intermediate-high
- 23/154 (14.9%)
- High
- 9/154 (5.8%)
Additional interventions during specialist follow-up
- Required additional interventions
- 8/154 (5.2%)
Primary care surveillance practices
- Tg testing
- 11/154 (7.1%)
- No routine neck US; stable levothyroxine dosing
Premature re-referral to specialist care, without evidence of recurrence
- Re-referred
- 13/154 (8.4%)
Patient-reported outcomes at reassessment
- High fear of recurrence
- 66/154 (42.9%)
- Preferred specialist follow-up
- 141/154 (91.6%)
Original publication
Prospective Evaluation of Follow-Up De-Escalation to Primary Care in Differentiated Thyroid Cancer with Excellent Response to Therapy. Thyroid. Published 25 May 2026. doi:10.
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