Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Importance of Postoperative Stimulated Thyroglobulin Level at the Time of 131I Ablation Therapy for Differentiated Thyroid Cancer

  • Hasbek, Zekiye (Nuclear Medicine, Medicine School, Cumhuriyet University) ;
  • Turgut, Bulent (Nuclear Medicine, Medicine School, Cumhuriyet University) ;
  • Kilicli, Fatih (Department Endocrinology, Medicine School, Cumhuriyet University) ;
  • Altuntas, Emine Elif (Department Ear Noise and Thourat, Medicine School, Cumhuriyet University) ;
  • Yucel, Birsen (Department Radiation Oncology, Medicine School, Cumhuriyet University)
  • Published : 2014.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Serum thyroglobulin detection plays an essential role during the follow-up of thyroid cancer patients treated with total/near total thyroidectomy and radioiodine ablation. The aim of this retrospective study was to evaluate the relationship between stimulated serum thyroglobulin (Tg) level at the time of high dose $^{131}I$ ablation and risk of recurrence, using a three-level classification in patients with differentiated thyroid cancer (DTC) according to the ATA guidelines. Also we investigated the relationship between postoperative stimulated Tg at the time of ablation and DxWBS results at 8-10 months thereafter. Materials and Methods: Patients with radioiodine accumulation were regarded as scan positive (scan+). If there was no relevant pathological radioiodine accumulation or minimal local accumulation in the thyroid bed region, this were regarded as scan negative (scan-) at the time of DxWBS. We classified patients in 3 groups as low, intermediate and high risk group for assessment of risk of recurrence according to the revised ATA guidelines. Also, we divided patients into 3 groups based on the stimulated serum Tg levels at the time of $^{131}I$ ablation therapy. Groups 1-3 consisted of patients who had Tg levels of ${\leq}2ng/ml$, 2-10 ng/ml, and ${\geq}10ng/ml$, respectively. Results: A total of 221 consecutive patients were included. In the high risk group according to the ATA guideline, while 45.5% of demonstrated Scan(+) Tg(+), 27.3% of patients demonstrated Scan(-) Tg(-); in the intermediate group, the figures were 2.3% and 90.0% while in the low risk group, they were 0.6% and 96.4%. In 9 of 11 patients with metastases (81.8%), stimulated serum Tg level at the time of radioiodine ablation therapy was over 10, however in 1 patient (9.1%) it was <2ng/mL and in one patient it was 2-10ng/mL (p=0.005). Aggressive subtypes of DTC were found in 8 of 221 patients and serum Tg levels were ${\leq}2ng/ml$ in 4 of these 8. Conclusions: We conclude that TSH-stimulated serum thyroglobulin level at the time of ablation may not determine risk of recurrence. Therefore, DxWBS should be performed at 8-12 months after ablation therapy.

Keywords

References

  1. Baudin E, Cao CD, Cailleux AF, et al (2003). Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients. J Clin Endocrinol Metab, 88, 1107-11. https://doi.org/10.1210/jc.2002-021365
  2. Berger F, Friedrich U, Knesewitsch P, Hahn K (2011). Diagnostic $^{131}I$ whole-body scintigraphy 1 year after thyroablative therapy in patients with differentiated thyroid cancer: correlation of results to the individual risk profile and longterm follow-up. Eur J Nucl Med Mol Imaging, 38, 451-8. https://doi.org/10.1007/s00259-010-1657-0
  3. Castagna MG, Maino F, Cipri C, et al (2011). Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur J Endocrinol, 165, 441-6. https://doi.org/10.1530/EJE-11-0466
  4. Cooper DS, Doherty GM, Haugen BR, et al (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 91, 1167-214.
  5. Durante C, Costante G, Filetti S (2013). Differentiated thyroid carcinoma: defining new paradigms for postoperative management. Endocr Relat Cancer, 20, 141-54. https://doi.org/10.1530/ERC-13-0066
  6. Francis Z, Schlumberger M (2008). Serum thyroglobulin determination in thyroid cancer patients. Best Pract Res Clin Endocrinol Metab, 22, 1039-46. https://doi.org/10.1016/j.beem.2008.09.015
  7. Frasoldati A, Pesenti M, Gallo M, et al (2003). Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer, 97, 90-6. https://doi.org/10.1002/cncr.11031
  8. Ibrahimpasic T, Nixon IJ, Palmer FL, et al (2012). Undetectable thyroglobulin after total thyroidectomy in patients with lowand intermediate-risk papillary thyroid cancer--is there a need for radioactive iodine therapy? Surgery, 152, 1096-105. https://doi.org/10.1016/j.surg.2012.08.034
  9. Ito Y, Kudo T, Kihara M, et al (2012). Prognosis of low-risk papillary thyroid carcinoma patients: its relationship with the size of primary tumors. Endocr J, 59, 119-25. https://doi.org/10.1507/endocrj.EJ11-0288
  10. Kim TY, Kim WB, Kim ES, et al (2005). Serum thyroglobulin levels at the time of $^{131}I$ remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab, 90, 1440-5. https://doi.org/10.1210/jc.2004-1771
  11. Koh JM, Kim ES, Ryu JS, et al (2003). Effects of therapeutic doses of $^{131}I$ in thyroid papillary carcinoma patients with elevated thyroglobulin level and negative 131-I whole-body scan: comparative study. Clin Endocrinol, 58, 421-7. https://doi.org/10.1046/j.1365-2265.2003.01733.x
  12. Kucukalic-Selimovic E, Alagic J, Valjevac A, et al (2012). The value of serum thyreoglobulin levels and whole body (I-131) scintigraphy in the follow-up of the thyroid cancer patients after thyroidectomy. Coll Antropol, 2, 67-71.
  13. Lee JI, Chung YJ, Cho BY, et al (2013). Postoperative-stimulated serum thyroglobulin measured at the time of 131-I ablation is useful for the prediction of disease status in patients with differentiated thyroid carcinoma. Surgery, 153, 828-35. https://doi.org/10.1016/j.surg.2012.12.008
  14. Leenhardt L, Erdogan MF, Hegedus L, et al (2013). Europan Thyroid Association Guidelines for cervical ultrasound scan and ultrasound-guide techniques in the postoperative mangement of patients with thyroid cancer. Eur Thyroid J, 2, 147-59. https://doi.org/10.1159/000354537
  15. Nascimento C, Borget I, Al Ghuzlan A, et al (2011). Persistent disease and recurrence in differentiated thyroid cancer patients with undetectable postoperative stimulated thyroglobulin level. Endocr Relat Cancer, 18, 29-40.
  16. Pacini F, Capezzone M, Elisei R, et al (2002). Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab, 87, 1499-501. https://doi.org/10.1210/jcem.87.4.8274
  17. Tuttle RM, Tala H, Shah J, et al (2010). Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid, 20, 1341-9. https://doi.org/10.1089/thy.2010.0178

Cited by

  1. Diagnostic value of Thyroglobulin Measurement with Fine-needle Aspiration Biopsy for Lymph Node Metastases in Patients with a History of Differentiated Thyroid Cancer vol.15, pp.24, 2015, https://doi.org/10.7314/APJCP.2014.15.24.10905
  2. Factors Affecting Disease-Free Status of Differentiated Thyroid Carcinoma Patients vol.16, pp.2, 2015, https://doi.org/10.7314/APJCP.2015.16.2.737
  3. Role of ultrasound in the assessment of percutaneous laser ablation of cervical metastatic lymph nodes from thyroid carcinoma pp.1600-0455, 2017, https://doi.org/10.1177/0284185117721261