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Diagnostic 131Iodine Whole-Body Scan May Be Avoided in Thyroid Cancer Patients Who Have Undetectable Stimulated Serum Tg Levels After Initial Treatment

Diagnostic 131Iodine Whole-Body Scan May Be Avoided in Thyroid Cancer Patients Who Have Undetectable Stimulated Serum Tg Levels After Initial Treatmen

Diagnostic 131Iodine Whole-Body Scan May Be Avoided in Thyroid Cancer Patients Who Have Undetectable Stimulated Serum Tg Levels After Initial Treatment   (Citations: 78)
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The follow-up of differentiated thyroid cancer after total thy- roidectomy and thyroid ablation is commonly based on serum Tg determination and 131-iodine (131I) diagnostic whole-body scan (WBS) performed in the hypothyroid state, 6 -12 months after thyroid ablation. Based on the greater sensitivity of Tg measurement, with respect to WBS, the diagnostic yield of diagnostic WBS has been questioned in patients who are off L-T4 therapy and have undetectable Tg levels. The aim of the present retrospective study was to evaluate the diagnostic relevance of 131I WBS performed after thyroid remnant ablation, in patients with undetectable serum Tg and off thyroid hormone therapy. The study included 315 of 662 consecutive patients (47.6%) treated in our department be- tween 1980 and 1990, who, at the first control WBS after thy- roid ablation, had undetectable serum Tg levels in the hypo- thyroid state. There were 54 men (17%) and 261 women (83%), with a mean age of 40.9 13.1 yr (range, 12-76), followed for a mean of 12 2.8 (range, 9 -19) yr. The control WBS was negative in 225 (71.4%) patients and positive for persistent areas of thyroid bed uptake, frequently of very low significance, in 90 (28.6%). No local or distant metastases were discovered. At the last follow-up visit (1999-2000), 281 (89.2%) patients showed complete remission, with undetectable serum Tg off L-T4 and negative WBS. Persistent thyroid bed uptake, with unde- tectable levels of Tg, was observed in 29 patients (9.2%) studied during L-T4 withdrawal. Only 2 patients (0.6%) experienced local recurrence (lymph-node metastases) during their follow-up. In conclusion, our data suggest that the presence of unde- tectable levels of serum Tg off L-T4 at the time of the first control WBS after initial treatment, is highly predictive of complete and persistent remission. With the exception of de- tecting persistent thyroid bed uptake in a minority of cases, the control WBS has never given information that could in- fluence the following therapeutic strategy. On this basis, we propose that the diagnostic 131I WBS may be avoided in pa- tients with undetectable levels of Tg off L-T4. These patients may be monitored with clinical examination, neck ultra- sound, and serum Tg measurements on L-T4 .( J Clin Endocri- nol Metab 87: 1499 -1501, 2002)
Journal: Journal of Clinical Endocrinology & Metabolism - J CLIN ENDOCRINOL METAB , vol. 87, no. 4, pp. 1499-1501, 2002
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    • ...En el análisis multivariable de los factores considerados al diagnóstico, las metástasis ganglionares se hallaron como único factor predictivo independiente de enfermedad persistente a los 5 años tanto en el grupo total (odds ratio [OR] = 13,6 [2,1-86,3]; p < 0,05) como en el subgrupo de los 57 CPT (OR = 15,3 [2,1-106,6]; p < 0,05)...
    • ...En el análisis multivariable de los factores considerados al diagnóstico, las metástasis ganglionares se hallaron como único factor predictivo independiente de enfermedad persistente a los 5 años tanto en el grupo total (odds ratio [OR] = 13,6 [2,1-86,3]; p < 0,05) como en el subgrupo de los 57 CPT (OR = 15,3 [2,1-106,6]; p < 0,05)...

    CRISTINA FAMILIARet al. Factores relacionados con la persistencia de la enfermedad a los 5 año...

    • ...The enthusiasm for TG testing in general and for FNA with TG testing in the aspirates contrasts even more with the strict recommendation against dxWBS in patients at low risk for recurrence (recommendation 46, rating F). To support this last recommendation, the ATA guidelines cite a review article [23], a letter to the editor [24], and the studies of Pacini et al. [25] and of Torlontano and colleagues [26], in both of which all patients ...

    Markus Dietleinet al. One should not just read what one believes: the nearly irresolvable is...

    • ...A study by Pacini et al. [17] concluded that the combination of clinical examination, TSH-stimulated Tgmeasurement and neck ultrasonography would suffice to monitor DTC patients, and that 131 I WBS did not reveal any...

    Frederik Anton Verburget al. No survival difference after successful 131 I ablation between patient...

    • ...This was the basis for two recent consensus reports, according to which, when there is no evidence of disease at 9–12 months after initial treatment with neck US and serum Tg determined after TSH stimulation, routine diagnostic 131I-TBScanbeavoidedatleastinlow-riskpatients(12,13).When this early evaluation does not show any evidence of disease, the risk of subsequent recurrence is low (10, 11)...
    • ...Neck US was not performed on a routine basisat9–12months,becauseitwasnotroutinelyusedatthe time of the study initiation, but previous studies on similar patients have shown that the risk of subsequent recurrence is small (0.5% at 10 yr) when neck palpation and control diagnostic TBS are normal and serum Tg remains undetectable after TSH stimulation (10, 11)...
    • ...Although the standard procedure for Tg measurement is 72hafterthesecondrhTSHinjection,peakrhTSHstimulated Tg occurs earlier (24–48 h after the second injection) in 32% of patients (11)...

    M. Schlumbergeret al. Comparison of Seven Serum Thyroglobulin Assays in the Follow-Up of Pap...

    • ...However, our speculation is supported by the results of at least two similar studies (7, 8) performed in patients studied by thyroid hormone withdrawal, showing that when stimulated serum Tg is less than the institutional cutoff,therateofrecurrenceisverylow(1%)ata12-yrfollow-up...

    M. G. Castagnaet al. Limited Value of Repeat Recombinant Human Thyrotropin (rhTSH)Stimulate...

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