Int J Thyroidol.  2024 May;17(1):115-146. 10.11106/ijt.2024.17.1.115.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part II. Follow-up Surveillance after Initial Treatment 2024

• Kim M
• Bang JI
• Kang HC
• Kim SW
• Na DG
• Park YJ
• Seo Y
• Song YS
• Oh SW
• Lee SW
• Lee EK
• Lee JY
• Lim DJ
• Chong A
• Chung YJ
• Hong CM
• Lee MK
• Kim BH
• Korean Thyroid Association Guideline Committee on the Managements of Thyroid Nodule and Cancer

• KMID: 2556510
• DOI: http://doi.org/10.11106/ijt.2024.17.1.115

Abstract

Based on the clinical, histopathological, and perioperative data of a patient with differentiated thyroid cancer (DTC), risk stratification based on their initial recurrence risk is a crucial follow-up (FU) strategy during the first 1–2 years after initial therapy. However, restratifiying the recurrence risk on the basis of current clinical data that becomes available after considering the response to treatment (ongoing risk stratification, ORS) provides a more accurate prediction of the status at the final FU and a more tailored management approach. Since the 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and DTC, the latest guidelines that include the National Comprehensive Cancer Network clinical practice and European Association for Medical Oncology guidelines have been updated to reflect several recent evidence in ORS and thyroid-stimulating hormone (TSH) suppression of DTC. The current clinical practice guideline was developed by extracting FU surveillance after the initial treatment section from the previous version of guidelines and updating it to reflect recent evidence. The current revised guideline includes recommendations for recent ORS, TSH target level based on risk stratification, FU tools for detection of recurrence and assessment of disease status, and long-term FU strategy for consideration of the disease status. These evidence-based recommendations are expected to avoid overtreatment and intensive FU of the majority of patients who will have a very good prognosis after the initial treatment of DTC patients, thereby ensuring that patients receive the most appropriate and effective treatment and FU options.

Keyword

Differentiated thyroid cancer; Risk of recurrence; Dynamic risk assessment; TSH suppression; Korean Thyroid Association; Guideline

Figure

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  Fig. II.2.3.A 질병 상태 평가에 따른 TSH 목표 농도 및 추적 검사.17) *고위험군: 5년 이후 환자의 나이와 동반된 질환 등을 고려하여 TSH 목표 농도를 완화한다. 중간위험군: 추적 기간 중(5년 이내 가능), 동반된 임상병리학적 위험인자를 종합한 재발위험도와 추적 중 갑상선글로불린 및 갑상선글로불린항체 농도 변화, 나이, 동반질환 등을 고려하여 TSH 목표 농도를 완화한다. 18F-FDG-PET: FDG 양전자 방출 단층 촬영, Rx WBS: 방사성요오드 치료 후 전신스캔검사

Reference

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