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The value of diagnostic whole-body scanning and serum thyroglobulin in the presence of elevated serum thyrotropin during follow-up of anti-thyroglobulin antibody-positive patients with differentiated thyroid carcinoma who appeared to be free of disease after total thyroidectomy and radioactive iodine ablation.
Thyroid. 2012 Feb; 22(2):113-6.T

Abstract

BACKGROUND

In the presence of anti-thyroglobulin antibodies (TgAb), serum thyroglobulin (Tg) might be underestimated. Therefore, the American Thyroid Association does not recommend serum Tg after thyroid hormone withdrawal or recombinant human thyrotropin administration (stimulated Tg) and diagnostic whole-body scanning (DxWBS) in TgAb-positive patients who have serum Tg values while on thyroxine (Tg-on-T4) of <1 ng/mL. The objective of this study was to determine, in patients with differentiated thyroid cancer (DTC) who appeared to be free of disease after surgery and ablative treatment, but who had positive serum TgAb, the value of performing DxWBS and obtaining serum Tg under stimulated Tg conditions.

METHODS

There were 121 women and 15 men in the study. By selection criteria, all of them had total thyroidectomy with apparent complete tumor resection, remnant ablation with (131)I (1.1-5.5 GBq), and a post-(131)I therapy WBS that were negative for ectopic (131)I uptake. On assessment 8-12 months after (131)I ablation, their clinical exam needed to be normal, their Tg-on-T4 needed to be <1 ng/mL, and the test for TgAb needed to be positive. Stimulated Tg, neck ultrasound (US), and DxWBS were obtained from all patients. Patients with stimulated Tg >1 ng/mL without disease on US and DxWBS were evaluated by other imaging methods.

RESULTS

In 10 (7.3%) patients, stimulated Tg was >1 ng/mL. The DxWBS revealed metastases in two of these patients, and other imaging methods showed disease in three others. Stimulated Tg was <1 ng/mL in 126 patients. DxWBS revealed metastases in three of these patients, and US detected lymph node metastases in four with a negative DxWBS. Tg stimulation combined with DxWBS revealed evidence for disease in 13 (9.5%) patients. When excluding patients with a positive US, DxWBS revealed metastases in four patients, and stimulated Tg of >1 ng/mL led to detection of persistent disease by other imaging methods in two more patients.

CONCLUSIONS

Performing stimulated Tg and DxWBS at the same time seems to be useful after initial therapy in DTC patients with TgAb who do not otherwise appear to have persistent disease, even when US is negative.

Authors+Show Affiliations

Postgraduate Program, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil. pedrorosario@globo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

22224815

Citation

Rosario, Pedro Weslley, et al. "The Value of Diagnostic Whole-body Scanning and Serum Thyroglobulin in the Presence of Elevated Serum Thyrotropin During Follow-up of Anti-thyroglobulin Antibody-positive Patients With Differentiated Thyroid Carcinoma Who Appeared to Be Free of Disease After Total Thyroidectomy and Radioactive Iodine Ablation." Thyroid : Official Journal of the American Thyroid Association, vol. 22, no. 2, 2012, pp. 113-6.
Rosario PW, Mineiro Filho AF, Lacerda RX, et al. The value of diagnostic whole-body scanning and serum thyroglobulin in the presence of elevated serum thyrotropin during follow-up of anti-thyroglobulin antibody-positive patients with differentiated thyroid carcinoma who appeared to be free of disease after total thyroidectomy and radioactive iodine ablation. Thyroid. 2012;22(2):113-6.
Rosario, P. W., Mineiro Filho, A. F., Lacerda, R. X., dos Santos, D. A., & Calsolari, M. R. (2012). The value of diagnostic whole-body scanning and serum thyroglobulin in the presence of elevated serum thyrotropin during follow-up of anti-thyroglobulin antibody-positive patients with differentiated thyroid carcinoma who appeared to be free of disease after total thyroidectomy and radioactive iodine ablation. Thyroid : Official Journal of the American Thyroid Association, 22(2), 113-6. https://doi.org/10.1089/thy.2011.0020
Rosario PW, et al. The Value of Diagnostic Whole-body Scanning and Serum Thyroglobulin in the Presence of Elevated Serum Thyrotropin During Follow-up of Anti-thyroglobulin Antibody-positive Patients With Differentiated Thyroid Carcinoma Who Appeared to Be Free of Disease After Total Thyroidectomy and Radioactive Iodine Ablation. Thyroid. 2012;22(2):113-6. PubMed PMID: 22224815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The value of diagnostic whole-body scanning and serum thyroglobulin in the presence of elevated serum thyrotropin during follow-up of anti-thyroglobulin antibody-positive patients with differentiated thyroid carcinoma who appeared to be free of disease after total thyroidectomy and radioactive iodine ablation. AU - Rosario,Pedro Weslley, AU - Mineiro Filho,Augusto Flávio Campos, AU - Lacerda,Rafela Xavier, AU - dos Santos,Davi Alves, AU - Calsolari,Maria Regina, Y1 - 2012/01/06/ PY - 2012/1/10/entrez PY - 2012/1/10/pubmed PY - 2012/6/2/medline SP - 113 EP - 6 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 22 IS - 2 N2 - BACKGROUND: In the presence of anti-thyroglobulin antibodies (TgAb), serum thyroglobulin (Tg) might be underestimated. Therefore, the American Thyroid Association does not recommend serum Tg after thyroid hormone withdrawal or recombinant human thyrotropin administration (stimulated Tg) and diagnostic whole-body scanning (DxWBS) in TgAb-positive patients who have serum Tg values while on thyroxine (Tg-on-T4) of <1 ng/mL. The objective of this study was to determine, in patients with differentiated thyroid cancer (DTC) who appeared to be free of disease after surgery and ablative treatment, but who had positive serum TgAb, the value of performing DxWBS and obtaining serum Tg under stimulated Tg conditions. METHODS: There were 121 women and 15 men in the study. By selection criteria, all of them had total thyroidectomy with apparent complete tumor resection, remnant ablation with (131)I (1.1-5.5 GBq), and a post-(131)I therapy WBS that were negative for ectopic (131)I uptake. On assessment 8-12 months after (131)I ablation, their clinical exam needed to be normal, their Tg-on-T4 needed to be <1 ng/mL, and the test for TgAb needed to be positive. Stimulated Tg, neck ultrasound (US), and DxWBS were obtained from all patients. Patients with stimulated Tg >1 ng/mL without disease on US and DxWBS were evaluated by other imaging methods. RESULTS: In 10 (7.3%) patients, stimulated Tg was >1 ng/mL. The DxWBS revealed metastases in two of these patients, and other imaging methods showed disease in three others. Stimulated Tg was <1 ng/mL in 126 patients. DxWBS revealed metastases in three of these patients, and US detected lymph node metastases in four with a negative DxWBS. Tg stimulation combined with DxWBS revealed evidence for disease in 13 (9.5%) patients. When excluding patients with a positive US, DxWBS revealed metastases in four patients, and stimulated Tg of >1 ng/mL led to detection of persistent disease by other imaging methods in two more patients. CONCLUSIONS: Performing stimulated Tg and DxWBS at the same time seems to be useful after initial therapy in DTC patients with TgAb who do not otherwise appear to have persistent disease, even when US is negative. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/22224815/The_value_of_diagnostic_whole_body_scanning_and_serum_thyroglobulin_in_the_presence_of_elevated_serum_thyrotropin_during_follow_up_of_anti_thyroglobulin_antibody_positive_patients_with_differentiated_thyroid_carcinoma_who_appeared_to_be_free_of_disease_after_total_thyroidectomy_and_radioactive_iodine_ablation_ DB - PRIME DP - Unbound Medicine ER -