Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer

Massimo Torlontano, Umberto Crocetti, Leonardo D'Aloiso, Nazario Bonfitto, Anna Di Giorgio, Sergio Modoni, Guido Valle, Vincenzo Frusciante, Michele Bisceglia, Sebastiano Filetti, Martin Schlumberger, Vincezo Trischitta

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The 'standard' postoperative follow-up of patients with differentiated thyroid cancer (DTC) has been based upon serum thyroglobulin (Tg) measurement and 131I whole body scan (131I-WBS) after thyroid hormone (T4) treatment withdrawal. However, 131I-WBS sensitivity has been reported to be low. Thyroid hormone withdrawal, often associated with hypothyroidism-related side effects, may now be replaced by recombinant human thyroid stimulating hormone (rhTSH). The aim of our study was to evaluate the diagnostic accuracy of 131I-WBS and serum Tg measurement obtained after rhTSH stimulation and of neck ultrasonography in the first follow-up of DTC patients. Design: Ninety-nine consecutive patients previously treated with total thyroidectomy and 131I ablation, with no uptake outside the thyroid bed on the post-ablative 131I-WBS (low-risk patients) were enrolled. Methods: Measurement of serum Tg and 131I-WBS after rhTSH stimulation, and ultrasound examination (US) of the neck. Results: rhTSH-stimulated Tg was ≤ 1 ng/ml in 78 patients (Tg-) and > 1 ng/ml (Tg+) in 21 patients, including 6 patients with Tg levels > 5 ng/ml. 131I-WBS was negative for persistent or recurrent disease in all patients (i.e. sensitivity = 0%). US identified lymph-node metastases (confirmed at surgery) in 4/6 (67%) patients with stimulated Tg levels > 5 ng/ml, in 2/15 (13%) with Tg > 1 <5 ng/ml, and in 2/78 (3%) who were Tg-negative. Conclusions: (i) diagnostic 131I-WBS performed after rhTSH stimulation is useless in the first follow-up of DTC patients; (ii) US may identify lymph node metastases even in patients with low or undetectable serum Tg levels.

Original languageEnglish
Pages (from-to)19-24
Number of pages6
JournalEuropean Journal of Endocrinology
Volume148
Issue number1
DOIs
Publication statusPublished - Jan 1 2003

ASJC Scopus subject areas

  • Endocrinology

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