Patients after thyroid cancer surgery face multiple challenges, including recurrence monitoring, medication adjustment, complication management (e.g., hypoparathyroidism, vocal cord dysfunction), and long-term psychosocial adaptation. Studies confirm that standardized long-term follow-up can raise 5-year survival rates to over 90% and significantly reduce disability and mortality in patients with thyroid dysfunction. Despite the recognized importance of follow-up, conventional practice has major limitations. The traditional model relies on passive patient return visits, either when symptoms appear or at fixed intervals. Adherence is influenced by patients' health awareness, education, geographic distance, finances, and work obligations. Consequently, loss to follow-up and delayed follow-up are common. Clinical data from China show that follow-up adherence drops from less than 60% at one year post-surgery to below 40% at three years. Many patients experience disease progression or treatment delays, increasing their physical and psychological burden, as well as healthcare costs. Physicians face high clinic workloads, fragmented patient information, and difficulty tracking long-term outcomes. Furthermore, conventional follow-up lacks personalized plans-timing, content, and methods are uniform, making it difficult to meet diverse patient needs. Poor communication and delayed information transfer further undermine follow-up quality. In response, a patient-centered, proactive, structured, and full-cycle health management approach has become a new direction for chronic cancer care. Our hospital has introduced the "Follow-up Package (Proactive Postoperative Follow-up Program)," an innovative model that integrates several scheduled in-person specialty visits, interdisciplinary referral resources, convenient online consultation channels, and an AI-based automated reminder system into an annual service. This proactive model shifts from "passive patient return" to "active hospital-led management." It clarifies follow-up timelines, diversifies service formats, strengthens doctor-patient communication, and creates a seamless, responsive management loop. For patients, this approach offers clearer management pathways, stronger support, and improved access to care. For the healthcare system, it enables more efficient disease management through optimized resource allocation and early detection of problems. By transforming follow-up from a passive, episodic task into an active, continuous partnership, the program addresses the key shortcomings of conventional models-low adherence, lack of personalization, and poor communication-and holds promise for better clinical outcomes and more sustainable use of medical resources.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
244
Proactive Postoperative Follow-up Program (including scheduled in-person clinic visits, interdisciplinary referrals, online consultation channels, and AI-based automated reminders)
West China hospital of Sichuan University
Chengdu, Sichuan, China
RECRUITINGCompletion Rate of Scheduled In-Person Clinic Visits
Compare the proportion of scheduled in-person clinic visits completed within the predefined follow-up time windows (postoperative month 1 ± 7 days, month 3 ± 14 days, month 6 ± 14 days, month 12 ± 30 days) during the first year after surgery between the two groups. Additionally, calculate separately the proportion of patients in each group who completed the in-person clinic visit within each predefined follow-up time window.
Time frame: 1 month postoperatively;3 months postoperatively;6 months postoperatively;12 months postoperatively
TSH suppression target achievement rate
Proportion of patients who achieve the TSH suppression goal within the specified measurement time points.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Median time to TSH suppression target achievement
The median time to achieve the TSH suppression goal within the specified measurement time points.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Patient Satisfaction Score
Assessed using the Client Satisfaction Questionnaire (CSQ-8). This satisfaction score is assessed only for patients in the intervention group, to understand their level of satisfaction with the active follow-up intervention.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Completion rate and accuracy rate of key examinations
Whether the thyroid function tests, serum calcium, parathyroid hormone (PTH) tests, and thyroid ultrasound recommended by clinical guidelines and/or the medical team were completed at the time of postoperative outpatient follow-up visits (yes/no), as well as the proportion of missed or unnecessary (excessive) examinations.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Questionnaire completion rate
The proportion of questionnaires completed by patients in both groups at each time point and within one year after surgery.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Timely management rate of post-discharge complications
The time to management of thyroid surgery-related complications occurring after hospital discharge will be collected, and the rate of timely management of complications will be compared between the two groups.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
Oncological safety
The proportion of patients in both groups who develop recurrence or distant metastasis during the follow-up period will be collected.
Time frame: 1 month postoperatively; 3 months postoperatively; 6 months postoperatively; 12 months postoperatively
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