Dynamic Risk Stratification

What is it, and why is it done?

Technically DRS as described in current guidelines only applies if you have had RAI, although there is increasing interest in applying it after total thyroidectomy.

Dynamic risk stratification (DRS) refers to the process of re-evaluating the risk of recurrence of thyroid cancer once treatment, including radioiodine, has been completed.

An initial risk assessment is made following surgery, once the pathology report is available, giving full details about the cancer. However, we know that even cancers initially thought to be at high risk of recurrence may be reclassified as being at lower risk if there is a good response to radioiodine therapy.

The re-evaluation is based on the results of a neck ultrasound scan and blood test for thyroglobulin, undertaken 6-12 months after radioiodine treatment. If these tests are both clear then we know that the patient is at very low risk of thyroid cancer recurrence and this may then affect the recommended level of thyroid hormone replacement and the frequency of follow-up required.

You probably won’t be told that DRS has been done but will know how things are via test results.