{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T06:45:01Z","timestamp":1782629101100,"version":"3.54.5"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dynamic risk stratification (DRS) enables response-adapted follow-up in differentiated thyroid carcinoma (DTC). However, prospective data supporting surveillance de-escalation and discharge to primary care (PC) after an excellent response (ER) is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted a longitudinal cohort study with a prospectively conducted postdischarge reassessment, including 154 patients with DTC treated with total thyroidectomy, with or without radioiodine ablation, who completed \u22655 years of specialist follow-up and were discharged to PC after achieving ER. A small subset (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 9) of clinically stable patients was also discharged despite a persistent indeterminate response (IR), based on clinical judgment. Patients underwent a standardized reassessment \u22655 years after discharge to PC. DRS was assessed at three predefined time points 6 months after initial therapy, final predischarge specialist visit, and postdischarge reassessment. Outcomes included recurrence, additional interventions, real-world PC follow-up practices, referrals back to specialist care, and patient-reported outcomes collected at reassessment using a study-specific 5-point Likert-type questionnaire.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Baseline American Thyroid Association-2025 recurrence risk was low 78\/154 (50.6%), intermediate-low 44\/154 (28.6%), intermediate-high 23\/154 (14.9%), and high 9\/154 (5.8%). ER increased from 118\/154 (76.6%) at 6 months to 145\/154 (94.2%) at predischarge and to 148\/154 (96.1%) at postdischarge reassessment (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). At last predischarge visit, 9\/154 (5.8%) had an IR, decreasing to 6\/154 (3.9%) at postdischarge reassessment. No biochemical or structural recurrences were observed over a mean postdischarge follow-up of 70.3 \u00b1 10.6 months. All non-ER findings at reassessment occurred exclusively in patients already classified as IR at discharge, with no deterioration from ER. During specialist follow-up, 8\/154 (5.2%) required additional interventions. PC surveillance was characterized by low-intensity follow-up, with thyroglobulin testing in 11\/154 (7.1%), no routine neck ultrasound, and stable levothyroxine dosing. Premature re-referral to specialist care occurred in 13\/154 (8.4%) without evidence of recurrence. Despite favorable outcomes, 66\/154 (42.9%) reported high fear of recurrence and 141\/154 (91.6%) preferred specialist follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our findings suggest that patients with DTC who complete \u22655 years of specialist follow-up and achieve ER may be safely transitioned to PC. ER represents a stable clinical state, with minimal risk of clinically meaningful recurrence even with markedly reduced biochemical and imaging surveillance. These findings support a response-adapted long-term care model centered in PC, focused on thyroid hormone replacement and TSH monitoring. Further studies are warranted to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256261454209","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T17:03:16Z","timestamp":1779728596000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Evaluation of Follow-Up De-Escalation to Primary Care in Differentiated Thyroid Cancer with Excellent Response to Therapy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7710-0670","authenticated-orcid":false,"given":"Pablo","family":"Fern\u00e1ndez Velasco","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Torres","sequence":"additional","affiliation":[{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Est\u00e9vez Asensio","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Cocho Cuesta","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria de la O.","family":"Nieto de la Marca","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ortol\u00e1 Buigues","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"G\u00f3mez Hoyos","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"de Luis Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Centro de Investigaci\u00f3n de Endocrinolog\u00eda y Nutrici\u00f3nCl\u00ednica (CIENC), Universidad de Valladolid Facultad de Medicina, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9743-9412","authenticated-orcid":false,"given":"Gonzalo","family":"D\u00edaz Soto","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."},{"name":"Valladolid Health Research Institute (IBioVALL), Valladolid, 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