Preventing thyroid cancer recurrence after surgery

  Review within two years after surgery is key: Because 90% of recurrences occur within two years, review once a month after surgery, then again at three months, and once every three months thereafter until two years. The review will be done every six months from three to five years, and once a year from five to ten years. After ten years, there is basically no need to review. The second part of the review is to focus on thyroid function, thyroid ultrasound, and if necessary, X-ray and CT, according to which the doctor will adjust the dosage of thyroxine tablets and assess the postoperative recovery and whether there are signs of metastasis.  Endocrine treatment can effectively reduce the recurrence rate: Endocrine treatment is postoperative oral thyroid hormone. Some data show that the recurrence rate of thyroid cancer patients given surgery alone is 32%, and the recurrence rate is reduced to 11% with surgery plus thyroxine treatment. The rationale for this is that studies have found that differentiated thyroid cancer cells express TSH receptors on their membrane surface, which can respond to TSH stimulation and promote the growth of thyroid follicular epithelium. Therefore, the negative feedback regulation by levothyroxine, which keeps TSH to a relatively low level, can reduce recurrence and improve the prognosis of thyroid cancer patients. Therefore, this method is called “TSH suppression therapy” in clinical practice.  The main side effects of long-term TSH suppression therapy are: 1. subclinical hyperthyroidism, palpitations, sweating, dry mouth, and weight loss; 2. angina pectoris in patients with ischemic cardiomyopathy; 3. atrial fibrillation in elderly patients; 4. osteoporosis in postmenopausal women. Therefore, people who take oral thyroxine tablets after surgery should pay attention to observation, and seek medical consultation without reason for heartburn, and adjust the dosage of medicine under the guidance of doctors. Adequate calcium supplementation (1200 mg/d) as well as vitamin D (1000 U/d) is also needed.