Thyroid cancer: follow-up after treatment (TSH, thyroglobulin, calcitonin)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Differentiated cancer after total thyroidectomy
Laboratory tests (same laboratory and same assay each time)
- TSH
- Thyroglobulin
- Anti-thyroglobulin antibodies (quantitative assay, same sample)
- Every 6 to 12 months at first; every 12 to 24 months after an excellent response (low or intermediate risk). TSH at least once a year on levothyroxine.
Do not order
- Thyroglobulin without anti-thyroglobulin antibodies on the same sample: in the presence of antibodies, Tg is falsely low and the result cannot be interpreted [2].
- Changing laboratory or assay kit from one Tg measurement to the next: results vary by up to a factor of two depending on the kit, and it is the trend that matters [2].
Differentiated cancer after lobectomy
6 to 8 weeks after lobectomy
- TSH
- Thyroglobulin and anti-thyroglobulin antibodies, once only (if requested by the specialist)if neededATA 2025 considers that a single Tg measurement 6 to 12 weeks after lobectomy, with a normal TSH, may help check that it is not abnormally high, with no established threshold [3]; later surveillance by Tg is not recommended [3,8].
Then at least once a year (on levothyroxine)
- TSH
Do not order
- Thyroglobulin and anti-thyroglobulin antibodies to monitor a cancer treated by lobectomy: not recommended, surveillance relies on neck ultrasound [8].
Medullary cancer
4 to 6 weeks after thyroidectomy
- TSH
3 months after thyroidectomy
- Calcitonin
- CEA
- Then calcitonin and CEA every 6 months for 1 year, then once a year if undetectable or normal; at least every 6 months if detectable.
After thyroidectomy: hypoparathyroidism
Before the procedure (fasting)
- Serum calcium
12 to 24 hours after the procedure
- Serum calcium
- PTH (on the same sample)
Also consider
Do not order
Sources (10)
- Borson-Chazot F, Borget I, Mathonnet M, Leenhardt L. SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Epidemiology and challenges in the management of thyroid nodules. Ann Endocrinol (Paris). 2022;83(6):378-379.
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
- Ringel MD, Sosa JA, Baloch Z, et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025;35(8):841-985.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0821 (thyroglobuline), 1484 (anticorps anti-thyroglobuline), 1132 (calcitonine), 7327 (ACE) et 0983 (parathormone).
- National Institute for Health and Care Excellence. Thyroid cancer: assessment and management. NICE guideline NG230, 19 décembre 2022, sections 1.4 à 1.6 (Royaume-Uni).
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Schilddrüsenkarzinom, Langversion 1.3, septembre 2026, AWMF 031-056OL, chapitres 6 et 8.3 (Allemagne).
- Federatie Medisch Specialisten. Richtlijn Schildkliercarcinoom, 30 septembre 2024, modules « Thyreoglobuline bepaling », « Beeldvormende technieken en handvat follow-up », « Aanvullende behandelmodaliteiten » et « Peri-postoperatieve zorg » (Pays-Bas).
- Leboulleux S, Lamartina L, Lecornet Sokol E, Menegaux F, Leenhardt L, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Follow-up: How and how long? Ann Endocrinol (Paris). 2022;83(6):407-414.
- Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610.
- Haute Autorité de santé, Centre de référence des maladies rares du métabolisme du calcium et du phosphate. Protocole national de diagnostic et de soins (PNDS) : Hypoparathyroïdie. Mars 2025.