Postoperative assessment after thyroid cancer surgery

Last revised by Daniel J Bell on 08 Aug 2022

Postoperative assessment after thyroid cancer surgery is performed in the surgical bed and regional lymph nodes, looking for possible recurrence of disease.

Radiographic features

Ultrasound
  • usually performed in first 6-12 months, and then as needed by the patient's risk factors 1
  • suspicious lymph nodes are biopsied with fine needle aspiration (FNA)
    • thyroid cells in the node indicate a metastasis
    • if the FNA is non-diagnostic, an assay for elevated thyroglobulin in the sample will indicate a metastasis
  • ~34% of postoperative patients have small thyroid bed nodules 2
    • rate of growth is slow and 81% do not increase in size over a three-year period
    • only 33% of malignant nodules show interval growth
Nuclear medicine

content pending

CT

Ultrasound is the first line modality for evaluation of the postoperative neck.

CT may be useful in certain situations 4:

  • bulky and widely distributed recurrent nodal disease, where ultrasound may not completely delineate disease

  • assessment of possible invasive recurrent disease where potential aerodigestive tract invasion requires complete assessment

  • when neck ultrasound is felt to be inadequately visualizing possible neck nodal disease (e.g. high thyroglobulin, negative neck US)

When CT is employed in follow-up, this is often performed without contrast in the early post-operative period if radioiodine ablation has not been performed, since iodinated contrast can compete with radioiodine treatment for uptake. If a study with IV contrast is necessary, radioiodine can be administered 4–8 weeks following the injection of contrast medium 5.

Differential diagnosis

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