Followup of Patients with Papillary Thyroid Cancer: In Search of the Optimal Algorithm

BACKGROUND: Cervicalrecurrenceoccursinupto30%ofpatientsaftersurgicaltreatmentforpapillarythyroid cancer. This study sought to determine an appropriate algorithm for followup evaluation. STUDY DESIGN: Patients undergoing total thyroidectomy for papillary thyroid cancer were identified. Clinicopathologic data were recorded, as were the results of all followup evaluations including radioiodine scan, cervical ultrasonography, and serum thyroglobulin levels. The disease recurrencefree survival probability was estimated, and risk factors for recurrence were determined. RESULTS: Thyroidectomywithorwithoutneckdissectionwasperformedin162patients.Weexcluded36 patients (followup less than 6 months in 26, extracervical disease at diagnosis in 4, unknown tumorsizein6)fromtheanalysis.Oftheremaining126patients,109(86.5%)hadnoevidence of disease, with serum thyroglobulin 1 ng/mL at last followup; 4 (3.2%) had no evidence of disease (negative imaging), with serum thyroglobulin 1 ng/mL, and 13 (10.3%) had recurrent disease. Cervical recurrence occurred in nine patients, all detected by routine ultrasonography. Pulmonary metastases occurred in four patients; three were diagnosed by chest CT and one by radioiodine scan. Thyroid stimulating hormone-suppressed thyroglobulin levels were available in 11 of the 13 patients and were elevated in 9. Patients with high T stage (extrathyroidal extension), or high N stage had an increased risk of recurrence. CONCLUSIONS: Afollowupstrategyemphasizingroutinecervicalultrasonographyandunstimulatedthyroglobuliniseffectiveinidentifyingpatientswithrecurrentpapillarythyroidcancer,andmayminimize theindiscriminateuseoftherapeuticradioiodineforradiographicallyoccultdisease.Surgeryremains the optimal treatment of cervical recurrence, which is the dominant pattern of treatment failure. (J Am Coll Surg 2007;205:239–247. © 2007 by the American College of Surgeons)