Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy

Massimo Torlontano, Umberto Crocetti, Giovanni Augello, Leonardo D'Aloiso, Nazario Bonfitto, Antonio Varraso, Franca Dicembrino, Sergio Modoni, Vincenzo Frusciante, Anna Di Giorgio, Rocco Bruno, Sebastiano Filetti, Vincenzo Trischitta

Research output: Contribution to journalArticle

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Abstract

Context: Although the prognosis of papillary thyroid microcarcinoma (PTMC) is usually excellent, the optimal follow-up strategy has never been investigated. Objective: The objective of the study was to investigate the role of neck ultrasonography (US), whole-body scintigraphy (WBS), and serum thyroglobulin levels (Tg) after recombinant human (rh) TSH in the follow-up of very low-risk PTMC patients. Design: The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy. Setting: The study population consisted of ambulatory patients. Patients: Eighty consecutive patients diagnosed with PTMC, who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies, were included. Main Outcome Measures: WBS and Tg after both rhTSH and neck US were measured. Results: rhTSH-Tg was 1 ng/ml or less in 45 (Tg-) and more than 1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in two Tg (+) and one Tg (-) patients. rhTSH-Tg levels positively correlated with thyroid bed iodine uptake (r = 0.40, P <0.0001). To date (32 ± 13 months after surgery), all node-negative patients have undetectable Tg levels on LT 4 treatment and negative US. Conclusions: For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment: 1) WBS is useless; 2) US is highly sensitive in detecting node metastases; and 3) detectable rhTSH-Tg levels mainly depend on small normal tissue remnants. In this subgroup of PTMC patients, neck US might be regarded as a primary tool for the initial follow-up.

Original languageEnglish
Pages (from-to)60-63
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume91
Issue number1
DOIs
Publication statusPublished - Jan 2006

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Ultrasonography
Thyrotropin Alfa
Thyroglobulin
Thyrotropin
Radionuclide Imaging
Neck
Therapeutics
Neoplasm Metastasis
Antibodies
Anti-Idiotypic Antibodies
Iodine
Surgery
Papillary Thyroid Microcarcinoma
Tumors
Tissue
Thyroidectomy
Observational Studies
Thyroid Gland
Lymph Nodes
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy. / Torlontano, Massimo; Crocetti, Umberto; Augello, Giovanni; D'Aloiso, Leonardo; Bonfitto, Nazario; Varraso, Antonio; Dicembrino, Franca; Modoni, Sergio; Frusciante, Vincenzo; Giorgio, Anna Di; Bruno, Rocco; Filetti, Sebastiano; Trischitta, Vincenzo.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 91, No. 1, 01.2006, p. 60-63.

Research output: Contribution to journalArticle

Torlontano, Massimo ; Crocetti, Umberto ; Augello, Giovanni ; D'Aloiso, Leonardo ; Bonfitto, Nazario ; Varraso, Antonio ; Dicembrino, Franca ; Modoni, Sergio ; Frusciante, Vincenzo ; Giorgio, Anna Di ; Bruno, Rocco ; Filetti, Sebastiano ; Trischitta, Vincenzo. / Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy. In: Journal of Clinical Endocrinology and Metabolism. 2006 ; Vol. 91, No. 1. pp. 60-63.
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abstract = "Context: Although the prognosis of papillary thyroid microcarcinoma (PTMC) is usually excellent, the optimal follow-up strategy has never been investigated. Objective: The objective of the study was to investigate the role of neck ultrasonography (US), whole-body scintigraphy (WBS), and serum thyroglobulin levels (Tg) after recombinant human (rh) TSH in the follow-up of very low-risk PTMC patients. Design: The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy. Setting: The study population consisted of ambulatory patients. Patients: Eighty consecutive patients diagnosed with PTMC, who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies, were included. Main Outcome Measures: WBS and Tg after both rhTSH and neck US were measured. Results: rhTSH-Tg was 1 ng/ml or less in 45 (Tg-) and more than 1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in two Tg (+) and one Tg (-) patients. rhTSH-Tg levels positively correlated with thyroid bed iodine uptake (r = 0.40, P <0.0001). To date (32 ± 13 months after surgery), all node-negative patients have undetectable Tg levels on LT 4 treatment and negative US. Conclusions: For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment: 1) WBS is useless; 2) US is highly sensitive in detecting node metastases; and 3) detectable rhTSH-Tg levels mainly depend on small normal tissue remnants. In this subgroup of PTMC patients, neck US might be regarded as a primary tool for the initial follow-up.",
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AU - Crocetti, Umberto

AU - Augello, Giovanni

AU - D'Aloiso, Leonardo

AU - Bonfitto, Nazario

AU - Varraso, Antonio

AU - Dicembrino, Franca

AU - Modoni, Sergio

AU - Frusciante, Vincenzo

AU - Giorgio, Anna Di

AU - Bruno, Rocco

AU - Filetti, Sebastiano

AU - Trischitta, Vincenzo

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