Abstract
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 language | English |
|---|---|
| Pages (from-to) | 3402-3407 |
| Number of pages | 6 |
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Volume | 89 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Jul 2004 |
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ASJC Scopus subject areas
- Biochemistry
- Endocrinology, Diabetes and Metabolism
Cite this
Follow-up of low risk patients with papillary thyroid cancer : Role of neck ultrasonography in detecting lymph node metastases. / Torlontano, Massimo; Attard, Marco; Crocetti, Umberto; Tumino, Salvatore; Bruno, Rocco; Costante, Giuseppe; D'Azzò, Girolamo; Meringolo, Domenico; Ferretti, Elisabetta; Sacco, Rosario; Arturi, Franco; Filetti, Sebastiano.
In: Journal of Clinical Endocrinology and Metabolism, Vol. 89, No. 7, 07.2004, p. 3402-3407.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Follow-up of low risk patients with papillary thyroid cancer
T2 - Role of neck ultrasonography in detecting lymph node metastases
AU - Torlontano, Massimo
AU - Attard, Marco
AU - Crocetti, Umberto
AU - Tumino, Salvatore
AU - Bruno, Rocco
AU - Costante, Giuseppe
AU - D'Azzò, Girolamo
AU - Meringolo, Domenico
AU - Ferretti, Elisabetta
AU - Sacco, Rosario
AU - Arturi, Franco
AU - Filetti, Sebastiano
PY - 2004/7
Y1 - 2004/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=3242693043&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=3242693043&partnerID=8YFLogxK
U2 - 10.1210/jc.2003-031521
DO - 10.1210/jc.2003-031521
M3 - Article
C2 - 15240622
AN - SCOPUS:3242693043
VL - 89
SP - 3402
EP - 3407
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 7
ER -