Low Risk for Recurrence of Differentiated Thyroid Cancer: A Paradigm Shift to De-Escalation and Simplifying Care for Long Term Follow-up

Vollständiger Abstract

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The incidence of thyroid cancer in Canada increased from 1984 to 2013, followed by a subsequent decline; the most recent projections estimate 6,100 cases in 2026. Low-risk differentiated thyroid cancer (DTC), with an excellent treatment response, is associated with a recurrence risk of less than 2% and a 20-year disease specific mortality of less than 1%. In alignment with the 2025 American Thyroid Association DTC Guidelines and the Follow-up and Transition of Care for Low Recurrence Risk Thyroid Cancer Patients in Canada, thyroid cancer care is undergoing a major evolution. This shift is centred around de-escalation of care, and for the first time, provides guidance on when to consider cessation of surveillance. For patients who have undergone hemithyroidectomy, recommended follow-up includes a one-time post-operative measurement of thyroglobulin (TG) with thyroglobulin antibodies (TGAB), annual thyroid-stimulating hormone (TSH) monitoring (targeted within the reference range), and ultrasound surveillance at 1–3 years. Consideration may then be given to cessation of all monitoring after 5–8-years. For patients undergoing total thyroidectomy (TT) without radioactive iodine (RAI), the new target for a biochemical excellent response is