Follow up Approaches in Thyroid Cancer: A Risk Adapted Paradigm

The primary goal in the follow up of thyroid cancer patients is to identify and treat persistent and recurrent disease at a time that minimizes morbidity and disease specific mortality. This article presents a risk-adapted follow-up paradigm to guide both intensity and methodology of follow-up testing based on initial risk stratification, ongoing risk stratification, and secondary risk stratification that incorporates each of the well-known risk factors for recurrence and death from thyroid cancer, with a response to therapy variable as well as duration of disease-free survival. With a proper understanding of the biology of the disease and with accurate assessments of response to therapy, clinicians are better able to tailor a risk-appropriate follow-up approach to individual patients, minimizing excessive testing while still providing adequate testing to detect clinically significant disease recurrence in a timely fashion.