Follow-up of low risk patients with papillary thyroid cancer: Role of neck ultrasonography in detecting lymph node metastases

Massimo Torlontano, Marco Attard, Umberto Crocetti, Salvatore Tumino, Rocco Bruno, Giuseppe Costante, Girolamo D'Azzò, Domenico Meringolo, Elisabetta Ferretti, Rosario Sacco, Franco Arturi, Sebastiano Filetti

Research output: Contribution to journalArticlepeer-review


Persistent or recurrent disease is rare in low risk patients with papillary thyroid cancer, and follow-up of these patients is a matter of debate. Neck ultrasonography (US), serum thyroglobulin (Tg), and whole body scan (WBS) after T4 withdrawal were performed ia 456 patients, followed up to 5 yr. At the end of the first year, 335 patients were Tg negative, and 121 were Tg positive; 65 of 86 patients with Tg levels between 1 and 10 ng/ml became spontaneously Tg negative after 2 yr. During follow-up, WBS discovered node metastases in 13 subjects, and US discovered node metastases in 38 subjects (31 Tg positive and 7 Tg negative). WBS did not add any information, because all WBS-positive patients were also US and Tg positive. Fifty percent of metastases were less than 1 cm and not palpable. Finally, the negative predictive value of both negative Tg and US at first follow-up was 98.8%. We suggest a first follow-up based upon US assessment and stimulated (after T4 withdrawal or recombinant human TSH) serum Tg determination; subsequently, 1) US should not be mandatory at each examination in initially Tg- and US-negative subjects, but is strongly suggested in all other cases; 2) Tg determination should be repeated 1 yr later, after exogenous or endogenous TSH stimulation only in initially Tg-positive patients without any other evidence of residual disease; and 3) Tg measurement during therapy should be sufficient in all other cases.

Original languageEnglish
Pages (from-to)3402-3407
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Issue number7
Publication statusPublished - Jul 2004

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism


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