From Screening to Follow-up: A Review of Quality of Life and Psychological Status Across the Clinical Care Continuum in Patients with Differentiated Thyroid Cancer

Zifeng Kuang¹Xiaoyi Li^1*Hao Zhao²Chenjia Zhang¹

• ¹Department of General Surgery, Peking Union Medical College Hospital (CAMS), Beijing, China
• ²Beijing Shijitan Hospital Capital Medical University, Beijing, China

Background: The global incidence of differentiated thyroid cancer (DTC) has risen rapidly in recent years. Given its favorable prognosis, extended survival, and expanding patient population, the quality of life (QOL) and psychological well-being of patients have gained importance in DTC management. Methods: This narrative review summarizes recent research on the QOL and psychological health of DTC patients across all stages of clinical care continuum, including screening, diagnosis, treatment, and follow-up. Results: DTC patients commonly experience impaired QOL and psychological distress throughout the clinical care continuum. Thyroid screening and nodules detection often trigger anxiety and depression, although their severity and the need for medical intervention remain unclear. Patients undergoing fine-needle aspiration frequently experience anxiety regarding the potential diagnosis of malignancy. Even those diagnosed with benign nodules may experience anxiety due to the need for long-term surveillance and the uncertainty associated with the process. While patients with low-risk DTC managed by active surveillance generally report better QOL than those who undergo surgery, concerns regarding disease progression persist. Psychological factors significantly influence treatment decision-making. Conventional surgery can lead to adverse events that reduce QOL and increase psychological burden, while minimally invasive approaches may reduce scar-related concern but offer limited improvement in overall QOL. Furthermore, hypothyroidism prior to radioactive iodine therapy and the treatment-related adverse effects often lead to a transient decline in well-being, whereas the effects of TSH suppression therapy remain uncertain. Although many of these negative effects can resolve over time, DTC patients continue to report worse QOL and psychological well-being compared to the general population, which can be attributed to enduring fears of recurrence and insufficient informational and emotional support. Conclusion: DTC patients encounter significant challenges related to QOL and psychological health at all stages of management. There is a pressing need for comprehensive care and supportive interventions throughout the clinical continuum to enhance the overall health of DTC patients.