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Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma.
Clin Endocrinol (Oxf). 2008 Oct; 69(4):659-63.CE

Abstract

AIM

Thyroidectomy followed by administration of large activities of 131-iodine ((131)I) is the treatment of choice for differentiated thyroid carcinoma (DTC). The serum thyroglobulin (Tg) measurement during hypothyroidism (offT4-Tg), just before radioiodine thyroid ablation, has proved to be effective for predicting persistent/recurrent disease. However, the Tg measurement cannot be used as a corresponding value for pre-ablative offT4-Tg when recombinant human TSH (rhTSH) is used as stimulus before treatment. The present study was undertaken to evaluate if post-thyroidectomy Tg values, measured before rhTSH-stimulated radioiodine ablation is of prognostic value in patients affected by DTC.

METHODS

We enrolled 126 patients with DTC submitted to total thyroidectomy. T4 treatment was started just after surgery to suppress TSH levels and Tg levels (onT4-Tg) were measured just before rhTSH-aided thyroid ablation by (131)I (3700 MBq). Neck radioiodine uptake (RAIU) was measured just before ablation and a post-treatment whole body scan (PT-WBS) was performed.

RESULTS

A significant relationship was found between thyroid remnants' RAIU and onT4-Tg levels (P < 0.001). The 1.10 ng/ml onT4-Tg threshold selected by ROC curve analysis identifies patients with positive PT-WBS with 83.3% sensitivity, 65.7% specificity, 44.5% positive predictive value (PPV) and 93.6% negative predictive value (NPV). The 0.65 ng/ml cut-off level recognizes metastatic patients with 82.9% sensitivity, 55.2% specificity, 43.3% PPV and 97.8% NPV when compared with 12 months restaging results. Among 63 patients with initially undetectable onT4-Tg (i.e. <or= 0.2 ng/ml) none had positive PT-WBS nor DTC relapse at 12-month restaging (NPV 100%).

CONCLUSIONS

Based on our data we conclude that pre-ablative onT4-Tg is a prognostic marker and should be used instead of pre-ablative TSH-stimulated Tg measurement when rhTSH-aided radioiodine ablation is done.

Authors+Show Affiliations

Department of Nuclear Medicine and Thyroid Unit, Oncology Institute of Southern Switzerland, CH-6500 Bellinzona, Switzerland. luca.giovanella@eoc.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18363882

Citation

Giovanella, Luca, et al. "Thyroglobulin Measurement Before rhTSH-aided 131I Ablation in Detecting Metastases From Differentiated Thyroid Carcinoma." Clinical Endocrinology, vol. 69, no. 4, 2008, pp. 659-63.
Giovanella L, Ceriani L, Suriano S, et al. Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2008;69(4):659-63.
Giovanella, L., Ceriani, L., Suriano, S., Ghelfo, A., & Maffioli, M. (2008). Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma. Clinical Endocrinology, 69(4), 659-63. https://doi.org/10.1111/j.1365-2265.2008.03244.x
Giovanella L, et al. Thyroglobulin Measurement Before rhTSH-aided 131I Ablation in Detecting Metastases From Differentiated Thyroid Carcinoma. Clin Endocrinol (Oxf). 2008;69(4):659-63. PubMed PMID: 18363882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma. AU - Giovanella,Luca, AU - Ceriani,Luca, AU - Suriano,Sergio, AU - Ghelfo,Antonella, AU - Maffioli,Marco, Y1 - 2008/03/18/ PY - 2008/3/28/pubmed PY - 2009/8/14/medline PY - 2008/3/28/entrez SP - 659 EP - 63 JF - Clinical endocrinology JO - Clin. Endocrinol. (Oxf) VL - 69 IS - 4 N2 - AIM: Thyroidectomy followed by administration of large activities of 131-iodine ((131)I) is the treatment of choice for differentiated thyroid carcinoma (DTC). The serum thyroglobulin (Tg) measurement during hypothyroidism (offT4-Tg), just before radioiodine thyroid ablation, has proved to be effective for predicting persistent/recurrent disease. However, the Tg measurement cannot be used as a corresponding value for pre-ablative offT4-Tg when recombinant human TSH (rhTSH) is used as stimulus before treatment. The present study was undertaken to evaluate if post-thyroidectomy Tg values, measured before rhTSH-stimulated radioiodine ablation is of prognostic value in patients affected by DTC. METHODS: We enrolled 126 patients with DTC submitted to total thyroidectomy. T4 treatment was started just after surgery to suppress TSH levels and Tg levels (onT4-Tg) were measured just before rhTSH-aided thyroid ablation by (131)I (3700 MBq). Neck radioiodine uptake (RAIU) was measured just before ablation and a post-treatment whole body scan (PT-WBS) was performed. RESULTS: A significant relationship was found between thyroid remnants' RAIU and onT4-Tg levels (P < 0.001). The 1.10 ng/ml onT4-Tg threshold selected by ROC curve analysis identifies patients with positive PT-WBS with 83.3% sensitivity, 65.7% specificity, 44.5% positive predictive value (PPV) and 93.6% negative predictive value (NPV). The 0.65 ng/ml cut-off level recognizes metastatic patients with 82.9% sensitivity, 55.2% specificity, 43.3% PPV and 97.8% NPV when compared with 12 months restaging results. Among 63 patients with initially undetectable onT4-Tg (i.e. <or= 0.2 ng/ml) none had positive PT-WBS nor DTC relapse at 12-month restaging (NPV 100%). CONCLUSIONS: Based on our data we conclude that pre-ablative onT4-Tg is a prognostic marker and should be used instead of pre-ablative TSH-stimulated Tg measurement when rhTSH-aided radioiodine ablation is done. SN - 1365-2265 UR - https://www.unboundmedicine.com/medline/citation/18363882/Thyroglobulin_measurement_before_rhTSH_aided_131I_ablation_in_detecting_metastases_from_differentiated_thyroid_carcinoma_ L2 - https://doi.org/10.1111/j.1365-2265.2008.03244.x DB - PRIME DP - Unbound Medicine ER -