Objective: We assessed the contribution of initial treatment response to further refining prediction of individual outcomes in intermediate-risk papillary thyroid cancer (PTC) on the American Thyroid Association (ATA) risk stratification system. Dynamic risk stratification (DRS) as originally proposed by Tuttle et al. in 2010 was modified to also include serum antithyroglobulin antibodies (TgAb) as a surrogate marker of the likelihood of persistent disease, specifically in patients with thyroglobulin assay interference by TgAb.

Methods: 373 patients with ATA intermediate-risk PTC were enrolled retrospectively on medical records. Patients were followed at the National Oncology Institute after total thyroidectomy and I-131 therapy implemented between 2009 and 2013. Best response to initial therapy was classified as excellent, indeterminate, biochemically incomplete or structurally incomplete. Final disease status at a median 7.1 years’ follow-up was classified as no evidence of disease (NED), indeterminate, or persistent disease (either biochemically or structurally). Recurrence in initially excellent responders was noted.

Results: Excellent response was achieved by 164 patients (43.9%). At a median follow-up of 42 months, 19 (11.6%) had experienced recurrence. 87.4% of initially excellent responders available at the final checkpoint were NED, compared to 28% of those with biochemically or structurally incomplete response and 60.2% of all ATA intermediate-risk PTC patients.

Conclusions: Modified DRS further predicted individual outcomes in intermediate-risk PTC, potentially allowing ongoing management to be tailored accordingly.