Implementation and Evaluation of a Risk-Stratified Nurse-Led Thyroid Cancer Follow-Up Clinic: A Single-Centre Retrospective Service Evaluation

Background: Post-treatment surveillance for differentiated thyroid cancer (DTC) can extend for many years, contributing to increasing outpatient follow-up workload. Risk-stratified models that delegate selected low-risk follow-up to nurse-led clinics may improve sustainability if delivered within a robust governance framework. Methods: We undertook a single-centre retrospective service evaluation in a UK district general hospital to assess the implementation and safety of a nurse-led, risk-stratified thyroid cancer follow-up pathway. The evaluation period was July 14, 2020, to February 13, 2026. Sixty eligible low-risk DTC patients were analysed as a random sample: 30 follow-up encounters managed in a consultant-led clinic and 30 managed in a nurse-led clinic. A structured follow-up proforma standardised documentation of red flag symptom screening, wound assessment, voice assessment, and biochemical review (including calcium/parathyroid hormone where clinically indicated), and defined escalation criteria to consultant review. Results: In the nurse-led cohort, one patient required escalation for assessment of a submandibular swelling, with subsequent review confirming reactive lymphadenitis and return to the nurse-led pathway. The escalation proportion was 3.3% with a 95% confidence interval (CI) of 0.6%-16.7%. No missed malignancies, unplanned readmissions, or safety incidents were identified during the evaluation. Protocol compliance across safety domains in the nurse-led cohort was 100%. Conclusion: A governance-supported nurse-led thyroid cancer follow-up clinic for appropriately selected low-risk DTC patients can be delivered safely, with high protocol compliance and low escalation rates, supporting sustainable outpatient service redesign.