Thyroid Cancer Surveillance — How Will I Be Monitored After Treatment?

Generally speaking, we can frame the frequency of follow-up in two main periods: the first year following treatment and beyond the first year. However, this is not a one size fits all rule, and patients  may need more or fewer appointments according to their progress and needs.

“Anybody who has a diagnosis of thyroid cancer, who’s been treated for thyroid cancer, we do less frequent surveillance for low risk disease, a little bit more frequent for intermediate risk and much more frequent for high risk,” Dr. Kristen Otto, a head and neck/endocrine surgeon at Moffitt Cancer Center in Florida, tells SurvivorNet.

First Year After Treatment

In the first year after completing treatment, it’s common to see your doctor every three to six months. Most patients see their doctor (often an endocrinologist or oncologist) more frequently at the beginning.

These visits allow for close monitoring of hormone levels, ensuring you’re on the correct dose of thyroid hormone replacement and quickly addressing any unusual symptoms.

Beyond the First Year

• If All Results Are Stable: Your doctor might gradually reduce the frequency to every 6-12 months.
• Longer-Term Survivorship Care: If there’s no sign of recurrent cancer over a period — often several years — your doctor may decide to extend the interval to annual visits or possibly transition your care to a primary care physician, with occasional check-ins with a specialist.

The exact timing can vary widely. More aggressive or advanced cancers may require longer and closer surveillance, while small, low-risk cancers may allow for less frequent appointments once you are in remission.

“We know that for papillary thyroid cancer, if someone is going to have a recurrence, most likely it’s going to happen within the first five years. [The] highest percentage happen within the first three years, but we know out to five years we’ll catch 97 to 99% of recurrences,” Dr. Otto explains.

Common Tests and Evaluations

At your follow-up visits after treatment, your doctor will perform a series of tests to assess your overall health.

“The surveillance includes blood work, ultrasound, and office visit. Sometimes for the high risk patients, we add in scans because we can’t see, for instance, lung metastases on an ultrasound of the neck, we’d have to get a scan of the chest,” Dr. Otto explains.

Your healthcare provider will likely use a combination of the following tools and tests:

Blood Tests

• TSH (Thyroid-Stimulating Hormone): Helps your doctor see if your thyroid hormone replacement dose needs adjusting
• Free T4 (FT4): Another measure of thyroid hormone in your blood
• Thyroglobulin (Tg): After thyroid removal (and sometimes radioactive iodine), levels of thyroglobulin (a protein produced by thyroid cells) should be very low or undetectable. Rising levels may signal potential recurrence.

Neck Ultrasound

Ultrasound imaging of the neck is used to check for any suspicious lumps or lymph nodes. This is a key test in detecting local recurrences.

Imaging Tests (If Needed)

Sometimes other imaging (such as CT, MRI, or a radioactive iodine scan) may be recommended, especially if there are elevated thyroglobulin levels without a clear source.

Transitioning from Specialist to Primary Care

Many patients wonder when, if ever, they can leave the care of their oncologist or endocrinologist and return to primary care follow-up (seeing their local doctor).

This decision is highly individualized but typically involves:

• Consistency in “No Evidence of Disease”: If you’ve gone several years with stable, low (or undetectable) thyroglobulin levels, normal imaging results, and no suspicious symptoms, your doctor may consider reducing the frequency of specialist visits.
• Low-Risk Cancer: Individuals with smaller, low-risk thyroid cancers often have a smoother transition back to primary care, provided they remain stable.
• Shared Care Model: Sometimes, you may continue to see a primary care provider for routine health needs and an endocrinologist or oncologist once a year (or less) to monitor hormone levels and check for any signs of recurrence.

“If we follow a patient out through five years and there’s no evidence of disease at that point, at Moffitt Cancer Center, we generally then graduate our patients to back to their primary care doctor or to our survivorship program where they’re getting more long-term [care],” Dr. Otto says.

Your medical team will guide you on the safest timeline. They’ll make sure you understand the signs or symptoms that should prompt you to return to specialist care more quickly.

Knowing What to Watch For

Patients should monitor their health for any changes that may warrant a visit to the doctor, even when they are on a regular monitoring schedule.

Experts recommend the following:

• Keep an Eye on Any Neck Changes: Report new lumps, swelling, or discomfort in the neck to your doctor.
• Stay Alert to Thyroid Hormone Imbalance Symptoms: Fatigue, weight changes, temperature intolerance, or unusual heartbeat patterns can indicate a dosage issue with your thyroid medication.
• Stay in Contact with Healthcare Providers: Don’t wait for your next scheduled appointment if you have concerns. Reach out sooner.

Questions To Ask Your Doctor

• How frequently will I need to be monitored after treatment?
• Is there anything that would warrant a change to our monitoring schedule?
• What signs/symptoms of recurrence should I look out for at home?

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