How to review thyroid cancer

Thyroid cancer is an “angel” or a “demon” depending on whether it is reviewed on time!

We often talk about cancer.

We often talk about “cancer” in our lives, but thyroid cancer is known as “happy cancer”, “lazy cancer”, and “fake cancer” because of its low malignancy, slow growth rate, less likely to spread, and high cure rate in most cases. However, thyroid cancer is called “happy cancer”, “lazy cancer” and “fake cancer” because of its slow growth rate, slow spread and high cure rate. Many medical students even joke that “if you have to get cancer once in your life, get thyroid cancer”. But even if thyroid cancer is “mild and kind”, it is still cancer, and it has all the killing power that cancer has, such as recurrence, bone metastasis (10%-15%) and lung metastasis (2%-20%). The company’s main goal is to provide the best possible service to its customers.

Studies have found that about 30% of differentiated thyroid cancers will recur or metastasize, with 2/3 of them occurring within 10 years of surgery and a small number of cases continuing to recur or metastasize years after surgery. Therefore, to prevent recurrence after surgery, regular follow-up is key.

What to check for after thyroid cancer surgery?

How should I be followed up in the long term and when should I be reviewed afterwards? What should be checked? We have sorted out the following three tables (Tables 1 to 3) on exactly how to do this, etc. It is important to remind that each person’s situation is not quite the same, and the time and items for review may vary, so please refer to your doctor’s recommendation.

Table 1. Major review items for patients with differentiated thyroid cancer

Checking categories	Specific content	1 year post-op	1 to 2 years post-op	2 to 5 years post-op	>5 years post-op
Outpatient examination	Thyroid gland Palpation of cervical lymph nodes Examination of vocal cord mobility	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as hoarseness, choking, breath-holding, coughing up blood, or joint pain)
Laboratory tests	Thyroid function tests: Thyroid stimulating hormone (TSH) Triiodothyronine (T3) Thyroxine (T4) Free triiodothyronine (FT3) Free thyroxine (FT4)	Month 2, Month 4, Month 6, Month 8, Month 10, Month 12	Month 3, Month 6, Month 9, Month 12	Month 6, Month 12	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as hoarseness, choking, breath-holding, coughing up blood, or joint pain)
	Thyroglobulin (Tg)	Month 1, Month 6, Month 12	Month 6, Month 12	Month 6, Month 12
	Antithyroglobulin antibody (TgAb)
Imaging	Neck ultrasound examination	Month 3, Month 9, Month 12	Month 6, Month 12	Month 6, Month 12	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as hoarseness, choking, breath-holding, coughing up blood, or joint pain)
	Bone scan of the whole body	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12
	Diagnostic whole-body imaging with iodine 131 (Dx-WBS)	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12

Note:

1. Differentiated thyroid cancer includes papillary thyroid cancer and follicular thyroid cancer.
2. The items listed in the table are general principles. If your condition fluctuates, or if your doctor requires you to have a review, please be sure to follow your doctor’s orders.

Table 2. Major review items for patients with medullary thyroid cancer

Magnetic Resonance Imaging (MRI)

Checking categories	Specific content	1 year post-op	1 to 2 years post-op	2 to 5 years post-op	>5 years post-op
Outpatient examination	Thyroid gland Palpation of cervical lymph nodes Examination of vocal cord mobility	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as persistent diarrhea, palpitations, flushing)
Laboratory tests	Thyroid function tests: Thyroid stimulating hormone (TSH) Triiodothyronine (T3) Thyroxine (T4) Free triiodothyronine (FT3) Free thyroxine (FT4)	Month 2, Month 4, Month 6, Month 8, Month 10, Month 12	Month 3, Month 6, Month 9, Month 12	Month 6, Month 12	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as persistent diarrhea, palpitations, flushing)
	Calcitonin (Ctn)	Week 1, Month 1, Month 3, Month 6	Month 6	Month 6
	Carcinoembryonic antigen (CEA)
Imaging	Neck ultrasound examination	Month 3, Month 9	Month 3, Month 9	Month 3, Month 9	Regular annual follow-up is recommended, with prompt outpatient visits for examination when there are clinical manifestations (symptoms such as persistent diarrhea, palpitations, flushing)
	Whole body bone scan	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12
	Diagnostic whole-body imaging with iodine 131 (Dx-WBS)	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12
	Chest CT	Month 3, Month 9	Month 3, Month 9	Month 3, Month 9
	Month 6, Month 12	Month 6, Month 12	Month 6, Month 12

Note: The items listed in the table are general principles. If your condition fluctuates, or if your doctor requires you to review, please be sure to follow your doctor’s orders.

Table 3. Key review items for patients with undifferentiated thyroid cancer

Check the category	Specific content	1 year postoperatively	1 to 2 years postoperatively	2 to 3 years postoperatively
Imaging	Neck ultrasound	Month 1, Month 4, Month 6, Month 9, Month 12	Month 4, Month 8, Month 12	Month 6, Month 12
	CT or MRI (including: brain, chest, abdomen, pelvis)
	Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT)	Month 3	/	/
Laboratory tests	Thyroid function tests	Month 1, Month 4, Month 6, Month 9, Month 12	Month 4, Month 8, Month 12	Month 6, Month 12
	Blood workup
	Urinary routine (including: 24-hour urine calcium/phosphorus)
	Parathyroid hormone (PTH)
	Blood biochemistry (electrolytes, serum calcium/phosphorus, liver function)

Don’t take these symptoms lying down, get to the hospital!

Patients with thyroid cancer should pay special attention to the presence of a lump at the site of surgery or in the neck.
1. Once symptoms such as hoarseness, choking, breath-holding, coughing up blood or joint pain appear, it often indicates that the cancer may have recurred and progressed to a certain level, and it is recommended to go to the hospital immediately for examination.
2. If you experience weight loss, difficulty sleeping, rapid heartbeat, sweating, restlessness and other symptoms similar to hyperthyroidism while taking levothyroxine sodium tablets, it is recommended to visit the endocrinology department for a thyroid function test and adjust the dosage of the medication according to the doctor’s prescription, and remember not to reduce the dosage without authorization.

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3. When symptoms of hypothyroidism such as poor appetite, fear of cold, constipation, and weakness occur while taking levothyroxine sodium tablets, you should consult your doctor for dose adjustment and never increase the dosage without authorization.

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4. Patients with medullary thyroid cancer who experience symptoms such as intractable diarrhea, palpitations, and flushing are alerted to the possibility of disease recurrence and should be examined and seen by endocrinology and thyroid specialists as soon as possible.

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How to know if there is a relapse, you can start by understanding these terms in the report

1. For patients with differentiated thyroid cancer who have had their entire thyroid gland cleared, the presence of elevated serum Tg (>10 ug/L) suggests the possibility of recurrence or metastasis of differentiated thyroid cancer and requires contacting the physician for further testing as soon as possible.
2. Patients with medullary thyroid cancer whose serum tumor markers are above the normal range and continue to increase, especially when calcitonin (Ctn) values are >150 pg/ml, should be on high alert for further disease progression or recurrence and need further testing and evaluation.
3. If the words “microcalcifications, hypoechoic, marginal infiltrates, nodule aspect ratio >1” appear on the postoperative ultrasound report, pay special attention to it and promptly undergo further investigations.

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