Endocrine Abstracts

Background: Post-treatment monitoring of thyroid cancer depends on risk stratification for future recurrence or possible extra-thyroidal metastasis. Current guidance suggests that patients with favourable prognostic factors and a low likelihood of recurrence can be effectively monitored in community settings. This study explores the safety of community-based surveillance for stable low-risk thyroid cancer patients discharged from specialised thyroid clinic.

Methodology: A retrospective review of 26 thyroid cancer patients discharged from the thyroid clinic, Scunthorpe General Hospital to primary care surveillance in the period from 2021 to 2023 was conducted. The study involved a comprehensive review of diagnosis, histology reports, blood and radiology results, and clinic correspondence extracted from electronic medical records.

Results: During the study period, 26 patients with thyroid cancer were discharged for long-term primary care (community) surveillance. 73% were female and median age was 61 years (IQR 48-70). Among the discharged patients, papillary carcinoma (18) was the predominant histological diagnosis and 34.6% were micro carcinomas. Definitive treatment among the study population comprised of surgery with radio-iodine ablation (61.5%) and surgery alone (38.5%). Median duration of thyroid clinic follow-up prior to discharge was 12 years (IQR 8-17). Written recommendations for post-discharge screening protocol were provided to the general practitioners for all 26 patients. Compliance with the screening protocol was observed in 21 patients (81%); among these, only 5 patients underwent complete screening in accordance with the prescribed protocol (annual assessment of thyroid-stimulating hormone, thyroglobulin levels, and neck examination), while 16 patients had partial screening (less than annual, average interval of 18-24 months). There was no difference observed in screening uptake or frequency between age groups, gender, micro or macro carcinomas, and mode of primary treatment. Average TSH value was (1.46 mU/L ± 1.5); none had raised tumour markers (thyroglobulin) or positive finding to suggest recurrence.

Conclusion: Upon reviewing low-risk thyroid cancer patients discharged from Scunthorpe General Hospital’s thyroid clinic, it becomes apparent that community-based surveillance, following an initial period of specialist clinic follow-up, is safe and appropriate. To enhance the effectiveness of this approach, we propose improvement of the patient recall system incorporating automated prompts within the shared electronic medical records and utilising posted or emailed letter reminders. Additionally, we recommend sustained support from specialist teams through periodic audits and expert advice.