Elevated thyroglobulin levels and negative I-131 whole body scans: Six-year experience in United Arab Emirate

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16508-16508
Author(s):  
A. Uttamchandani ◽  
A. M. Maarraoui ◽  
N. M. Attia ◽  
H. A. Latif ◽  
M. A. Bakir ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cell Cancer ◽  
Thyroid Tissue ◽  
Elevated Serum ◽  
Lymphatic Invasion ◽  
Whole Body ◽  
High Dose ◽  
Serum Thyroglobulin ◽  
Female Ratio ◽  
Post Therapy

16508 Purpose: This is a retrospective study of thyroid cancer patients seen at Oncology Department at Mafraq Hospital/UAE from 1/1999 to 12/2005. Clinical data, prognostic factors and treatment outcomes were studied, special emphasis was put on patients with elevated Serum Thyroglobulin (TG) and negative I-131 whole body scans. Patients and Methods: Total of 144 patients were fully evaluated, intent to treat analysis was used. All patients were treated surgically and post-op thyroid technician 99 scan were performed. I-131 ablation was given if the tumor size was =1 cm or if =1 cm (micropapillary) and multi-focal. Post ablation scan was done on day 10 and thyroxin was given in suppressive doses. Periodic evaluations were done with TG level, I-131 whole body scan, neck US and CXR. Plain CT scans and PET scans were done in selected cases. Results: Male to female ratio 1:2.42, non-smokers were 90%, non-alcoholics were 99%, Diabetes and Hypertension were associated in 28% of cases, family history of thyroid cancer was noted in 8%, papillary carcinoma was seen in 85.8%, follicular cancer in 11.6%, hurthel cell cancer in 0.83% and medullary cancer in 0.17%. Vascular and lymphatic invasion was noted in 29% of all cases. Interesting all patients with vascular or lymphatic invasion relapsed locally or distantly. Post-operative thyroid scan showed residual thyroid tissue in 96% of cases. During follow up TG levels (cut off 5.0 ng/ml) were elevated in 52 patients (37% cohort). Diagnostic I-131 scans were done in 36 patients and were positive in 24 patients (67%) and negative in 12 patients (33%). In the 12 patient group of research interest with elevated TG and negative I-131 whole body scans, 9 received high dose I-131 therapy. Of these patients 8 (88%) showed positive post therapy scan and 1 (12%) showed negative post therapy scan. Conclusion: 1. TG is more sensitive marker than diagnostic I-131 scan in making treatment decisions. 2. Lympho vascular invasion has adverse prognostic value. No significant financial relationships to disclose.

Evaluation and treatment of persistent thyroglobulinemia in patients with well-differentiated thyroid cancer

1997 ◽  
pp. 254-261 ◽  
Author(s):  
J Pachucki ◽  
LA Burmeister
Keyword(s):  
Thyroid Cancer ◽  
High Rate ◽  
Whole Body ◽  
High Dose ◽  
Serum Thyroglobulin ◽  
131I Treatment ◽  
Measurable Serum ◽  
Well Differentiated ◽  
Therapeutic Doses ◽  
Post Therapy

Whereas in the past a negative diagnostic 131I whole body scan (WBS) was interpreted as the lack of significant residual or recurrent thyroid cancer, today the patient with negative WBS and measurable serum thyroglobulin (Tg) presents a diagnostic and therapeutic dilemma. Previous studies have shown a high rate of visualization of uptake and a decrease in Tg after one or more therapeutic doses of 131I. In order to further assess the significance of this finding, retrospective analysis of patients with persistent thyroglobulinemia and negative WBS was performed for evidence of surgically amenable disease. Seven out of seventeen patients had neck ultrasound and/or computerized tomography (neck +/- chest) showing the presence of pathologically confirmed malignant masses ranging from 1 to 4 cm in size. Their serum Tg while on L-thyroxine ranged between 2.4 and 1173 pmol/l. Removal of the identified masses resulted in a greater than 75% reduction in serum Tg in four out of five patients in the group. One patient achieved a serum Tg of < 1.5 pmol/l while hypothyroid. Empiric 131I treatment of eleven patients with persistent thyroglobulinemia resulted in demonstrated uptake on post-therapy scan in seven. Further study is needed to compare the efficacy, safety and cost of a diagnostic approach to radiologically identify and surgically resect identified disease versus empiric therapeutic 131I treatment and high-dose WBS in this group of patients. Patients with negative WBS and persistent thyroglobulinemia, even to levels < 4.5 pmol/l, may have significant foci of thyroid cancer in surgically accessible areas. This suggests the need for a redefinition or clarification of the term 'recurrence' in thyroid cancer.

scholarly journals Radioiodine treatment of metastatic differentiated thyroid cancer in patients on L-thyroxine, using recombinant human TSH

2001 ◽  
pp. 5-11 ◽  
Author(s):  
F Lippi ◽  
M Capezzone ◽  
F Angelini ◽  
D Taddei ◽  
E Molinaro ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Advanced Disease ◽  
Thyroid Stimulating Hormone ◽  
Whole Body ◽  
Suppressive Therapy ◽  
Serum Thyroglobulin ◽  
Body Scanning ◽  
Iodine 131 ◽  
Post Therapy

OBJECTIVE: This study tested the hypothesis that administration of human recombinant thyroid-stimulating hormone (rhTSH: Thyrogen, thyrotropin alpha) could promote iodine-131 ((131)I) uptake in the therapy for metastatic or locally invasive differentiated thyroid cancer (DTC), obviating L-thyroxine suppressive therapy (L-T4) withdrawal and hypothyroidism in patients with advanced disease. METHODS: Twelve totally (or almost completely) thyroidectomized adults, nine of whom had received earlier therapy after L-T4 withdrawal, underwent (131)I treatment while euthyroid on L-T4, after rhTSH administration. Nine underwent diagnostic whole-body scanning (WBS) after two consecutive daily i.m. injections (0.9 mg) of rhTSH. They then received an identical second course of rhTSH to promote therapeutic (131)I uptake. Post-therapy WBS was performed one week later. Three patients received only rhTSH (131)I therapy. RESULTS: Administration of rhTSH promoted (131)I uptake in all patients, as demonstrated by post-therapy WBS. Administration of rhTSH also promoted a significant increase in serum thyroglobulin (Tg) concentrations. According to the most recent measurements, 3-12 months after therapy, serum Tg levels fell in four, and stabilized in two out of eleven patients. Upon additional rhTSH-WBS 8 months post-study, a reduction in one metastatic site was noted in one patient. The rhTSH was well tolerated, with mild, transient fever and/or nausea occurring in only a minority of patients. Individuals with bone metastases experienced degrees of peritumoral pain and swelling that were similar (though more short-lived) to those seen in the same or other patients after L-T4 withdrawal. CONCLUSIONS: Administration of rhTSH is a safe, successful tool for inducing (131)I uptake in local and metastatic DTC lesions, and avoids L-T4 withdrawal, preserving metabolic homeostasis and preventing the debilitating effects of hypothyroidism.

scholarly journals A Comparison of Recombinant Human Thyrotropin and Thyroid Hormone Withdrawal for the Detection of Thyroid Remnant or Cancer1

1999 ◽  
Vol 84 (11) ◽  
pp. 3877-3885 ◽  
Author(s):  
Bryan R. Haugen ◽  
Furio Pacini ◽  
Christoph Reiners ◽  
Martin Schlumberger ◽  
Paul W. Ladenson ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Metastatic Disease ◽  
Effective Means ◽  
Thyroid Tissue ◽  
Whole Body ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal ◽  
Recombinant Human Tsh ◽  
Tsh Stimulation

Recombinant human TSH has been developed to facilitate monitoring for thyroid carcinoma recurrence or persistence without the attendant morbidity of hypothyroidism seen after thyroid hormone withdrawal. The objectives of this study were to compare the effect of administered recombinant human TSH with thyroid hormone withdrawal on the results of radioiodine whole body scanning (WBS) and serum thyroglobulin (Tg) levels. Two hundred and twenty-nine adult patients with differentiated thyroid cancer requiring radioiodine WBS were studied. Radioiodine WBS and serum Tg measurements were performed after administration of recombinant human TSH and again after thyroid hormone withdrawal in each patient. Radioiodine whole body scans were concordant between the recombinant TSH-stimulated and thyroid hormone withdrawal phases in 195 of 220 (89%) patients. Of the discordant scans, 8 (4%) had superior scans after recombinant human TSH administration, and 17 (8%) had superior scans after thyroid hormone withdrawal (P = 0.108). Based on a serum Tg level of 2 ng/mL or more, thyroid tissue or cancer was detected during thyroid hormone therapy in 22%, after recombinant human TSH stimulation in 52%, and after thyroid hormone withdrawal in 56% of patients with disease or tissue limited to the thyroid bed and in 80%, 100%, and 100% of patients, respectively, with metastatic disease. A combination of radioiodine WBS and serum Tg after recombinant human TSH stimulation detected thyroid tissue or cancer in 93% of patients with disease or tissue limited to the thyroid bed and 100% of patients with metastatic disease. In conclusion, recombinant human TSH administration is a safe and effective means of stimulating radioiodine uptake and serum Tg levels in patients undergoing evaluation for thyroid cancer persistence and recurrence.

scholarly journals Utility of99mTc-Hynic-TOC in 131I Whole-Body Scan Negative Thyroid Cancer Patients with Elevated Serum Thyroglobulin Levels

2015 ◽  
Vol 14 (2) ◽  
pp. 101 ◽  
Author(s):  
AjitS Shinto ◽  
Grace Samuel ◽  
Pavanasam Velayutham ◽  
Sharmila Banerjee ◽  
Suresh Damodharan ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Elevated Serum ◽  
Whole Body ◽  
Whole Body Scan ◽  
Body Scan ◽  
Serum Thyroglobulin

scholarly journals Diagnostic management of suspected metastatic thyroid carcinoma: clinical value of octreotide scintigraphy in patients with negative high-dose radioiodine scans

2004 ◽  
pp. 277-283 ◽  
Author(s):  
F Giammarile ◽  
C Houzard ◽  
C Bournaud ◽  
Z Hafdi ◽  
G Sassolas ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Somatostatin Receptor ◽  
Elevated Serum ◽  
Evaluation Criteria ◽  
High Dose ◽  
Clinical Value ◽  
Serum Thyroglobulin ◽  
Radioiodine Uptake ◽  
Positron Emission

OBJECTIVES: Somatostatin receptor scintigraphy (SRS) with (111)In-octreotide has been suggested as a potential tool for the detection of recurrent or metastatic differentiated thyroid cancer when no radioiodine uptake can be demonstrated in tumour sites. However, there is no consensus concerning the performance and clinical impact of this examination in such instances. DESIGN AND METHODS: A prospective study was undertaken to evaluate SRS in 43 patients (18 men, 25 women) with papillary (n=20), follicular (n=9), insular (n=6) and oncocytic (n=8) thyroid carcinomas with elevated serum thyroglobulin (Tg) levels and no detected radioiodine uptake. RESULTS: Evaluation criteria were interpreted in terms of an assumed presence of tumoural tissue. Sensitivity of SRS was 51%, clearly lower than that of conventional imaging procedures, and of positron emission tomography using [(18)F]-2-fluoro-2-deoxy-d-glucose, performed in a subset of 27 patients. In addition, we observed two false-positive foci of uptake of octreotide that corresponded to inflammatory pulmonary sites. The sensitivity was higher in patients with Tg levels greater than 50 microg/l (76%) for detecting mediastinal lesions (93%), and in patients with oncocytic cancer (88%). Finally, SRS changed treatment strategy in four patients. CONCLUSION: In differentiated thyroid cancer, SRS is a moderately sensitive method for the detection of lesions unable to concentrate iodine and appears useful only in patients with very high Tg levels or in oncocytic cancer.

scholarly journals Malignant Struma Ovarii with Concurrent Thyroid Cancer: Outcomes during and after Pregnancy

2021 ◽  
pp. 1-5
Author(s):  
Sara Donato ◽  
Helder Simões ◽  
Valeriano Leite
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Tissue ◽  
Pelvic Mass ◽  
Pregnant Patient ◽  
Whole Body ◽  
Ovarian Teratoma ◽  
Struma Ovarii ◽  
Pelvic Mri ◽  
Biochemical Evidence

<b><i>Introduction:</i></b> Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. <b><i>Case Presentation:</i></b> A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. <b><i>Discussion/Conclusion:</i></b> As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.

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