Active Surveillance Program for Low-Risk Papillary Thyroid Cancer

The typical approach to treating papillary thyroid cancer has been to surgically remove either part of the thyroid gland or the entire thyroid, often resulting in permanent hypothyroidism. While this approach is appropriate and works well for many patients, some people with small cancers may not necessarily need treatment and could avoid the risks of surgery.

Over the past 20 years, evidence has accumulated indicating that most cases of small papillary thyroid cancer can be safely followed without surgery. However, while most of these cancers remain stable, some progress, requiring surgical intervention.

Therefore, the safest way to follow patients who choose observation is through a formal program that includes ultrasound monitoring and periodic medical visits—a process called active surveillance. Doing this in a community setting may be challenging since most physicians are not as familiar with this process, and multidisciplinary teams with experience in thyroid cancer are needed to ensure appropriate patient selection, imaging evaluation, and follow up.

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Our Approach

At Yale, the Active Surveillance Program for Low-Risk Papillary Thyroid Cancer is overseen by a multidisciplinary team consisting of endocrinologists, endocrine surgeons, and radiologists. In general, patients with small (< 1.5 cm) papillary thyroid cancers who prefer to avoid or defer surgery are appropriate for the program. Once a patient is referred to the program, an assessment will be made to determine if they are right for the program. The initial assessment includes a physician consultation, a specialized thyroid and neck ultrasound, and the opportunity for surgical consultation.

After enrollment in the program, patients will have thyroid and neck ultrasound monitoring every six months for the first two years, along with periodic blood tests and at least one follow-up appointment each year. After the initial two years, if there are no concerning changes then ultrasound frequency deceases to every year. Surgery may be considered or pursued at any time if circumstances or patient-physician preferences change during follow-up appointments.