Evaluation and treatment of persistent thyroglobulinemia in patients with well-differentiated thyroid cancer (original) (raw)
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Hellenic journal of nuclear medicine, 2015
OBJECTIVE To study the clinical significance of stimulated high serum thyroglobulin (sTg) and of normal whole body imaging (WBI) in differentiated thyroid cancer (DTC) patients during their first follow-up and in a 5 years follow-up or till recurrence. SUBJECTS AND METHODS Sixty four DTC patients were retrospectively studied and were divided into two groups. Group 1, of 35 patients with disease free status on their first follow-up and group 2, of 29 patients with high sTg (>2 μg/mL), but with normal WBI, iodine-131 (¹³¹I) findings. Patients were categorized into low, intermediate and high risk patients based on the ¹³¹I WBS findings. Histology, stage and risk-categories of both groups were statistically correlated. Best sTg cut-off for predicting recurrence was generated by receiver operating characteristic (ROC). Odd ratio for sTg trend was also analyzed for risk of recurrence in group 2. Independent t test was used for progression free survival (PFS) comparison of the two group...
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2005
Thyroglobulin is considered a reliable marker of recurrent disease in patients with well-differentiated thyroid carcinoma. However, some patients present recurrence with no increase in serum thyroglobulin. In the attempt to identify patients who might present recurrence with no such sign of the disease, thyroglobulin levels have been determined pre-operatively in 185 consecutive patients scheduled for primary treatment for well-differentiated thyroid carcinoma from June 1997 to May 2002 at the Head and Neck Division of the European Institute of Oncology. In 22 patients (11.9% of total), serum thyroglobulin was undetectable. In none of these 22 cases was thyroglobulin detected during follow-up, either during thyroxin suppressive therapy or during withdrawal for radioiodine scan. One of these low-thyroglobulin patients developed recurrent disease involving cervical lymph nodes, with positive radioiodine scan: thyroglobulin remained undetectable. On the contrary, in the patients with h...
Thyroglobulin monitoring after treatment of well-differentiated thyroid cancer
European Journal of Surgical Oncology (EJSO), 2004
Aims. The prognosis for well-differentiated thyroid carcinomas is favourable after treatment, but the rate of recurrence is around 20%. Cervical ultrasonography, radio-iodine scans, and monitoring of serum thyroglobulin ðT g Þ levels allow these recurrences to be diagnosed. The management of patients with isolated elevated T g levels is controversial in the presence of negative radio-iodine scans. Methods. The records of 57 patients diagnosed with recurrence of welldifferentiated thyroid cancer were reviewed. Serum T g was not evaluated in 31 of these patients (group 1) and measured in the other 26 cases (group 2). Results. Forty-three recurrence sites were found; four deposits in the thyroid bed and 39 cervical metastatic nodes, with an average of five nodes per patient. The radioiodine scan was accurate in detecting 10/24 of cases, radiology in 9/17, and elevated T g levels in 20/25. Thirteen patients with recurrences diagnosed on the basis of T g levels had negative radio-iodine scans. After surgery, T g levels were normal in 10 patients from group 1 and 16 patients from group 2 ðp ¼ 0:0078Þ: Conclusions. Elevated T g levels are indicative of disease progression or recurrence in patients who have previously been operated on for well-differentiated thyroid cancer. Even when the radiological study or radio-iodine scan is normal, surgical re-exploration of the neck, with total thyroidectomy and lymphadenectomy, is advisable.
The Journal of Clinical Endocrinology & Metabolism, 2010
Design: This was a retrospective clinical study. Setting: The study was conducted at a university-based tertiary cancer hospital. Patients: One hundred seven patients had initial thyroid cancer surgery and subsequent remnant radioiodine ablation. Patients underwent recombinant human TSH (rhTSH)-mediated diagnostic whole-body scan and rhTSH-stimulated thyroglobulin (Tg) measurement before April 2001 if they had no antithyroglobulin antibodies, were clinically free of disease, and had one or more undetectable (≤0.5 ng/ml) or low (0.6–1 ng/ml) basal Tg measurements on levothyroxine. Patients were stratified according to their rhTSH-Tg responses: group 1, Tg 0.5 ng/ml or less (68 patients); group 2, Tg from 0.6 to 2.0 ng/ml (19 patients); and group 3, Tg greater than 2 ng/ml (20 patients). Main Outcome Measures: Tumor recurrence was measured. Results: In group 1, two of 62 patients (3%) with follow-up recurred. In group 2, 63% converted to group 1, whereas two of 19 (11%) converted to g...
Case Reports in Endocrinology
Over 50% of patients with papillary thyroid carcinoma (PTC) have cervical lymph-node metastasis on diagnosis, and up to 30% show nodal recurrence after surgery plus radioactive iodine (131I) (RAI) therapy. The combination of ultrasonography (US) and fine-needle aspiration cytology (FNAC) and the measurement of thyroglobulin (Tg) in washout fluid are cornerstones in the diagnosis of nodal metastasis. In the absence of anti-Tg antibodies, unstimulated serum thyroglobulin (Tg) levels are generally a reliable marker of recurrent disease, and 18F-FDG positron emission tomography (PET)/computed tomography (CT) plays an important role in the imaging work-up. We report the case of a 65-year-old man evaluated for a large multinodular goitre which caused compressive symptoms; the dominant nodule in the left lobe presented suspicious features on US. Thyroid function showed subclinical hypothyroidism, calcitonin was normal, serum thyroglobulin levels were low, and anti-thyroid antibodies were a...
Recurrent Differentiated Thyroid Cancer without Elevation of Serum Thyroglobulin
Thyroid, 2000
Thyroglobulin (Tg) is a reliable tumor marker in patients with well-differentiated thyroid cancer (WDTC). We identified 11 patients who had undetectable serum Tg and no thyroglobulin antibody (TgAb) in the presence of clinical disease. Three had residual disease after ablation of the thyroid by surgery plus radioiodine and 8 relapsed after a disease-free interval. Histologie review confirmed that 7 of the tumors were papillary carcinomas and 4 were follicular carcinomas. Immunohistochemical staining for Tg was positive in 6 of 7 papillary and in 3 of 4 follicular carcinomas. There were no identifiable histologie or clinical features that could be used to predict further patients who may relapse with absence of this serum marker. Negative serum Tg did not appear to be an adverse prognostic feature. During follow-up, measurement of Tg and TgAb should be supplemented by radioiodine scanning and radiological imaging in patients in whom recurrence is likely or suspected.
The Journal of Clinical Endocrinology & Metabolism, 2008
The 10-yr survival of differentiated thyroid cancer is about 76-93%, and at least 10% of patients manifest tumor persistence or recurrence, depending on their disease stage, after initial therapy, which typically includes total thyroidectomy and 131 I ablation. Previously the realization of their residual/recurrent cancer often presented simultaneously with the additional surprise that they lacked pathological uptake on their diagnostic whole-body radioiodine image despite their elevated stimulated serum thyroglobulin (Tg) level, a scenario referred to as the scan-negative, Tg-positive patient. Now that serum Tg and neck ultrasonography have supplanted the diagnostic whole-body scan because of its inferior sensitivity, patients are often recognized to harbor residual disease without radioiodine imaging, and a new challenging scenario has emerged: the ultrasonography-negative, Tg-positive patient. Similarities and differences of these two patient populations aside, these Tg-positive patients are frequently encountered, and some are considered for additional 131 I therapy, although now typically after negative anatomic ؎ 18 Ffluorodeoxyglucose positron emission tomography imaging or in the setting of known or suspected distant metastases already localized by anatomic imaging. Thus, the scan-negative, Tg-positive patient of today differs from those of the past, but the term still has relevance to current practice. The optimal evaluation and treatment of these patients remain controversial, partly because many of these patients will not die from thyroid cancer, and there are no randomized trials to demonstrate that intervention could have prevented the deaths that do occur. Here a case is presented that adds the complexity of advanced age, and one approach to these challenging patients is offered.
Thyroid, 2012
Background: Measurement of the serum thyroglobulin (Tg) level with TSH stimulation (sTg) is the cornerstone of monitoring for the recurrence or persistence of differentiated thyroid cancer (DTC) in patients who have undergone surgery and remnant ablation. However, there have been several reports that an undetectable sTg could not predict the absence of future recurrence. The aim of this study was to evaluate the long-term outcome of DTC patients who achieved biochemical remission (BR, defined as sTg < 1 ng/mL) after initial treatment, and to determine the role of repeated sTg measurement in detecting a clinical recurrence. Methods: This is a retrospective observational cohort study in a tertiary referral hospital. There were 1010 DTC patients who achieved BR at 12 months after the initial treatment (surgery and ablation), and they were eligible for analysis. Among them, 787 patients had values of repeated sTg. Results: Thirteen out of 1010 (1.3%) patients had clinical recurrences during a median 84 months of follow-up. All of the clinical recurrences were limited to the cervical lymph nodes without clinical evidence of distant metastasis. Among 787 patients with available repeated sTg, 10 had clinical recurrences (5 out of 750 patients with repeated sTg < 1 ng/mL and 5 out of 37 patients with repeated sTg ‡ 1 ng/mL). Patients with repeated sTg ‡ 1 ng/mL had a much greater chance of disease recurrence (log-rank statistics = 43.7, df = 1, p < 0.001). Conclusions: About 1% of DTC patients who had sTg < 1 ng/mL 12 months after initial treatment had a clinical recurrence. All of clinical recurrences were loco-regional recurrences. Although repeated sTg measurement can be helpful to predict recurrence, we could not recommend it for surveillance in patients with BR due to its very low yield.
Turkish Journal of Medical Sciences
Aim: Differentiated thyroid carcinoma has a favorable prognosis, even in the presence of distant metastases, if the tumor cells are able to concentrate radioiodine. Nonetheless, up to 30% of thyroid cancer patients with elevated serum thyroglobulin (Tg) and negative radioiodine whole-body scan findings represent a diagnostic dilemma. In this study we assessed the diagnostic contribution of anatomical and functional imaging procedures, including US of the thyroid bed and neck, CT scanning of the chest and mediastinum, and FDG PET whole-body scanning, in iodine-negative/Tg-positive thyroid cancer patients. Materials and methods: The study included 28 patients (20 female, 8 male; age range: 21-85 years; mean age: 56 years) with a proven diagnosis of thyroid carcinoma. The pathological diagnosis was papillary carcinoma in 26 patients, and Hurtle-cell carcinoma and poorly differentiated thyroid carcinoma, respectively, in the 2 remaining patients. All patients had undergone thyroid surgery and subsequent high-dose radioablation 3-8 years before participating in the study. In all, 27 patients presented with elevated serum Tg levels (3.1-3080 ng/mL, median 93) and 1 presented with multiple metastatic lesions in the lungs, despite the fact that Tg was within normal limits. All patients had a US examination of the thyroid bed and neck to determine if locoregional persistent disease was present. The patients were scheduled for high-dose radioiodine treatment because Tg was elevated after cessation of L-thyroxin for approximately 6 weeks. Those with a negative or equivocal post-treatment scan proceeded to whole-body 18-fluorodeoxyglucose PET. We assessed the diagnostic contribution of imaging procedures, including US of the thyroid bed and neck, CT of the chest and mediastinum, and PET, in patients that presented with elevated Tg levels and negative radioiodine scanning. Results: In total, 62 tumor sites were identified in the thyroid bed and neck (7 patients), lung and mediastinum (6 patients), both in the neck and lungs (5 patients), lung and bone (2 patients), neck and bone (1 patient), and neck, lung, and bone (1 patient). In 6 patients no thyroid tumor was detected with any imaging modality. US was useful in detecting cervical lymph nodes in 14 patients and CT revealed metastatic foci in the lung and mediastinum, and bone in 15 patients. In 25 patients post-treatment scanning was negative and in 3 there was faint uptake in the neck. FDG-PET revealed thyroid tumor sites in 18 patients; however, it was false-positive in 3 cases and missed 2 cervical adenopathies and 1 metastatic bone lesion. Conclusion: US and CT provided diagnostic information for detecting cervical adenopathy and metastatic lesions in the lungs and mediastinum, respectively. PET complemented the existing anatomical findings and enabled whole-body scanning in a single imaging session. It was particularly useful in detecting iodine-negative differentiated thyroid cancer associated with elevated serum Tg levels, thereby facilitating appropriate treatment.