Is lifelong follow-up necessary for low-risk papillary thyroid carcinoma? Case series and a review of the literature

• Published in: Journal of cancer research and therapeutics 2023-12, Vol.19 (Suppl 2), p.S1009-S1013
• Main Authors: Bahçecioğlu, Adile Begüm, Erdoğan, Murat Faik
• Format: Article
• Language: English
• Subjects: Care and treatment; Case studies; Metastasis; Patient outcomes; Primary care; Thyroid cancer
• ISSN: 0973-1482; 1998-4138
• DOI: 10.4103/jcrt.jcrt_1216_22

Late recurrences of papillary thyroid carcinoma (PTC) are seen rarely, especially for low-risk PTC. However, there are cases of late metastasis described in the literature, even four decades after the first treatment. We presented three low-risk PTC cases with late recurrences. In the first case, recurrence with distant organ metastasis without locoregional disease occurred 36 years after the first treatment. Recurrences in second and third cases were seen with lateral neck metastasis without central (skip metastasis), 17 and 10 years after the primary treatment. Initial treatment was ideal, and all three were followed with a complete response for years, after recurrences were diagnosed and appropriate treatments were administered. Increasing frequency of low-risk PTC increases medical costs of these patients. Thus, some suggest shortening the follow-up period not only because the increasing health burden but also because of the rarity of late recurrences as well. Some authors suggest that dynamically risk-stratified (DRS) low-risk thyroid cancer patients having excellent response to treatment after 5 years of follow-up can be discharged to primary care. Primary care facilities may follow patients with unmeasurable Thyroglobulin (Tg) levels; however, our cases suggest continuing thyroglobulin measurements (annual or at least every few years) for the exceptional but possible late recurrences.