Thyroid cancer: Long-term follow-up
Follow-up is crucial for all patients with thyroid cancer because thyroid cancer can return (i.e. recur), even many years after successful initial treatment. It is important that you choose your surgeon and endocrinologist carefully, as both of these physicians will often follow you for years to come. (See how do I find an experienced surgeon?) Therefore, a good long-term relationship with these doctors is important. Follow-up visits may include a careful history and physical examination, with particular attention to the neck area. An ultrasound of the neck may be performed to look for any signs of recurrence. Blood tests will be taken to measure your thyroid hormone levels to make sure you are taking enough hormone replacement and to look for an increase in a thyroid cancer marker, called thyroglobulin, that may indicate cancer recurrence. Depending on these tests, additional testing and possible further treatment with RAIRAI - radioactive iodine and/or surgery may be needed.
2. What is the surgeon's role in following patients with thyroid cancer?
Surgery is the best treatment for thyroid cancer. During the initial consultation with the thyroid surgeon, thyroid cancer patients learn much about their disease, including the overall favorable prognosis, the risks and benefits of thyroid surgery, and the general plan for follow-up after surgery. Important information is gathered from the operative findings and the final pathology report that influence the postoperative management strategy. The intensity and frequency of follow-up is determined by this information.
A partnership between the patient, the thyroid surgeon, and the endocrinologist is necessary to assure that the thyroid cancer patient receives appropriate follow-up care. As is true with any partnership, clear effective communication is needed. The surgeon must relay operative findings to the treating endocrinologist and assure that he/she receives a copy of operative and pathology reports. In turn, the endocrinologist should send the thyroid surgeon copies of post-operative laboratory and imaging results. These data are used to determine the risk for developing recurrent thyroid cancer in the future.
Your surgeon will oversee your care immediately before and after your thyroid surgery. Your endocrinologist will oversee your long-term management, including thyroid hormone replacement, radioactive iodine treatment (if recommended) and surveillance strategy. Many surgeons may choose to play a more active role in following thyroid cancer patients by performing such things as periodic physical examinations, lymph node inspections and surgeon-performed ultrasounds. Some physicians suggest evaluating high-risk patients every 6 months and low risk patients every 12 months. It is important to emphasize that these visits to your surgeon are not meant to replace the role of the endocrinologist, but rather to supplement endocrine medical management.