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Surveillance for recurrence of disease is essential and is based on: annual clinical examination, annual measurement of serum Tg and

TSH, and diagnostic scanning when indicated (isotopic imaging and/or ultrasound or CT scan). Follow-up should be life-long because thyroid cancer has a long natural history: late recurrences do occur, which can be successfully treated. Support and counseling are necessary, particularly in relation to pregnancy.

Years After Initial Therapy

Figure 2.3 Cumulative recurrence rate for DTC related to treatment given after initial surgery.(Reproduced from Mazzaferri EL, Thyroid cancer: impact of therapeutic modalities on prognosis, Chapter 10 in Thyroid Cancer (ed. Fagin JA), Kluwer Academic Publishers, Boston/Dordrecht London, 1998, pages 255-284.)

Years After Initial Therapy

Figure 2.3 Cumulative recurrence rate for DTC related to treatment given after initial surgery.(Reproduced from Mazzaferri EL, Thyroid cancer: impact of therapeutic modalities on prognosis, Chapter 10 in Thyroid Cancer (ed. Fagin JA), Kluwer Academic Publishers, Boston/Dordrecht London, 1998, pages 255-284.)

Serum thyroglobulin (Tg) is a very useful tumor marker that is used to monitor for recurrence, in patients who have been treated with thyroidectomy and 131I ablation.

Tg should be checked in all postoperative patients with differentiated thyroid cancer. It is best measured after TSH stimulation, but for routine follow-up of patients in remission it is acceptable to measure it while TSH is suppressed. If the Tg becomes elevated then steps must be taken to identify any focus of recurrent tumor.

Recombinant human TSH is now available and has an evolving role in the management of selected cases [19]. Recombinant human TSH (rhTSH) is used instead of stopping T3 or T4 prior to 131I scan or measurement of thyroglob-ulin, thus avoiding hypothyroidism with its debilitating symptoms. It is clearly indicated in patients who are unable to mount a TSH response to thyroid hormone withdrawal, and also those for whom an episode of hypothy-roidism is particularly undesirable, but may be used for any low risk patient for diagnostic purpose, provided serum Tg is undetectable on suppressive thyroxine therapy and anti-Tg antibodies are absent. Its potential therapeutic role has not yet been fully evaluated.

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