Evidence-based recommendation for subsequent thyroid cancer (IGHGa) b

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for subsequent thyroid cancer?

CAYA cancer survivors treated with

  • radiotherapy to a volume exposing the thyroid gland, including TBI
  • therapeutic 131I-MIBG

What surveillance modality should be used and at what frequency should it be performed?

  • Counselling regarding the increased risk for developing differentiated thyroid carcinoma, to inform their healthcare provider if they detect a thyroid mass (independent of the presence or absence of associated symptoms) at least every 5 years
  • Counselling regarding options for differentiated thyroid carcinoma surveillance (after radiotherapy to a volume exposing the thyroid gland) at least every 5 years
  • A physical examination of the neck as part of a complete physical exam whenever a survivor is assessed by a healthcare provider

If the decision to commence surveillance is made:c

  • A neck palpation, every 1-2 years starting 5 years after radiotherapy
  • A thyroid ultrasonography d every 3-5 years starting 5 years after radiotherapy

What should be done if abnormalities are identified?

  • Refer to the appropriate HCP


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

a This recommendation reflects the content of the IGHG Thyroid Cancer guideline (Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium, Cancer Treatment Reviews, 2018; accessible through

b Further recommendations regarding surveillance of thyroid function problems are specified in the Consensus-based recommendation for surveillance of thyroid function problems.

c The decision to commence surveillance and which modality to use should be made by the healthcare provider in consultation with the survivor after careful consideration of the advantages and disadvantages of differentiated thyroid carcinoma surveillance in the context of the survivor’s individual preferences, practice setting, the HCP’s experience and expertise of local diagnosticians (radiology) (see Overview of Advantages and Disadvantages). Healthcare providers should be aware that both diagnostic tests have advantages and disadvantages and can identify benign as well as malignant nodules resulting in need for invasive procedures.

d Ultrasound, FNA and/or biopsy should be performed in centers where there is experience in assessment of thyroid cancers so that appropriate interpretation of radiographic features and clinical risk factors can minimize the number of unnecessary invasive and additional diagnostic procedures. When ultrasound is used for surveillance, the cervical lymph node stations should always be visualized.