Late disease recurrence in patients diagnosed with and treated for differentiated thyroid carcinoma

Purpose: Differentiated thyroid carcinoma (DTC) is an uncommon cancer that typically has an excellent long-term prognosis. However, a frequent pitfall in the management of DTC is an underappreciation of the potential for recurrence after a lengthy disease-free interval. We report 6 cases of DTC that recurred more than 10 years after the initial diagnosis and treatment. Methods: During a recent review of the management of DTC at The University of Texas M. D. Anderson Cancer Center, we identified 4 male and 2 female patients whose disease recurred more than 10 years after the initial diagnosis. The patients were evaluated for demographic information, nature of recurrence, and status at last follow up. Results: Three patients had papillary thyroid carcinoma, one had follicular thyroid carcinoma, and 2 had mixed papillary/follicular thyroid carcinoma. Factors known to influence risk of recurrence (age at diagnosis, initial tumor size, local invasion, metastatic disease at presentation, extent of initial surgery, and radioiodine treatment) were assessed in our patients. In each case, failure to continue close foil led to delays in diagnosis of disease recurrence. Conclusion: In DTC, clinically significant recurrence may develop after a disease-free interval of many years. Therefore, lifelong surveillance is needed for these patients to ensure timely identification and early treatment.