LONG-TERM FOLLOW UP OF LOW RISK THYROID CANCER: A REAL-LIFE STUDY

INTRODUCTION. Recent evidence suggests reducing the intensity of care in thyroid carcinoma by referring patients with a low risk of recurrence and an excellent response to treatment to their general practitioner (GP). However, whether this approach demonstrates real clinical efficacy remains unknown. METHODS. This prospective observational study included patients from an oncology outpatient clinic who showed an excellent response to treatment according to the 2025 ATA guidelines and were referred to their GP between November 2021 and April 2026. For each patient, several variables were collected: sex, age, the interval from diagnosis to discharge, histological subtype, post-surgical hypoparathyroidism, and the type and timing of follow-up (FU) investigations. To evaluate FU outcomes, patients were contacted by phone, and their electronic health records were reviewed, after obtaining consent. Characteristics were then compared between patients who adhered to the FU protocol (all examinations performed within the scheduled timeframe +/- 3 months) and those who did not. RESULTS. Of the 353 discharged patients, 125 were excluded because they had not yet reached the scheduled time for their first FU. Among the remaining 228 patients, 77% were female, with a median age of 70 years and a median interval from diagnosis to discharge of 17 years. Regarding histotypes, 90.4% were treated for papillary carcinoma, 4.4% for follicular carcinoma, 2.6% for medullary carcinoma, 2.2% for oncocytic carcinoma, and 0.4% for NIFTP. All patients showed an excellent response to therapy. Permanent hypoparathyroidism was present in 9.6% of cases. GPs were advised to perform the following tests annually: TSH and fT4 (100% of patients), thyroglobulin and anti-thyroglobulin antibodies (94%), calcitonin (2.6%), calcium/phosphate/albumin levels (25%), and neck ultrasound (2,6%). A total of 74% (n=168) of the discharged patients responded to the phone call. Among them, 50.6% adhered to the recommended FU. Of the remaining 49.4%, the majority (72%) did not undergo any check-ups, while others only had TSH measured or failed to comply with the appropriate timing. Patients who respected the FU protocol did not differ significantly from those who did not regarding age (p=0.540), sex (p=0.851), the interval from diagnosis to discharge (p=0.192), histological subtype (p=0.593), or the presence of hypoparathyroidism (p=0.382). After a median FU of 27 months (range: 15–53), 1.7% of patients returned for an endocrinology consultation due to altered TSH levels. None of them returned due to signs of disease recurrence. CONCLUSIONS. Only half of the patients with low-risk thyroid carcinoma discharged from a secondary care center undergo the recommended FU investigations. However, no patients returned due to signs of disease recurrence within the year following discharge. Further studies are required to evaluate the potential long-term consequences of such low adherence to follow-up.