scholarly journals Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

2004 ◽  
Vol 150 (2) ◽  
pp. 105-112 ◽  
Author(s):  
M Schlumberger ◽  
G Berg ◽  
O Cohen ◽  
L Duntas ◽  
F Jamar ◽  
...  
Keyword(s):  
Work Productivity ◽  
Cost Savings ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
Whole Body ◽  
Human Thyroid ◽  
Serum Thyroglobulin ◽  
Risk Patients

OBJECTIVE: Because differentiated (follicular and papillary) thyroid cancer (DTC) may recur years after initial treatment, the follow-up of patients with DTC is long term. However, this population has changed, with more individuals being discovered at an earlier stage of the disease, so that previous follow-up protocols based mostly on data from high-risk patients no longer apply. We sought to develop an improved protocol for the follow-up of low-risk patients with DTC based on the findings of recent studies. METHODS: We analysed recent literature on the follow-up of DTC. RESULTS: Recent large studies have produced three important findings: (i) in patients with low-risk DTC with no evidence of disease up to the 6- to 12-month follow-up, diagnostic whole-body scan adds no information when serum thyroglobulin (Tg) is undetectable and interference from anti-Tg antibodies is absent; (ii) use of recombinant human thyroid-stimulating hormone to aid Tg measurement is effective and provides greater safety, quality-of-life and work productivity than does levothyroxine withdrawal with its attendant hypothyroidism; and (iii) ultrasonography performed by an experienced operator is the most sensitive means of detecting neck recurrences of DTC. CONCLUSIONS: We present a revised follow-up protocol for low-risk patients taking into account the above findings. This protocol should help clinicians enter a new era of monitoring characterized by greater safety, simplicity, convenience and cost savings.

scholarly journals A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid Carcinoma

2003 ◽  
Vol 88 (4) ◽  
pp. 1433-1441 ◽  
Author(s):  
E. L. Mazzaferri ◽  
R. J. Robbins ◽  
C. A. Spencer ◽  
L. E. Braverman ◽  
F. Pacini ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Clinical Evidence ◽  
Low Risk ◽  
Whole Body ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal ◽  
Body Scanning ◽  
Risk Patients

Recent studies have provided new information regarding the optimal surveillance protocols for low-risk patients with differentiated thyroid cancer (DTC). This article summarizes the main issues brought out in a consensus conference of thyroid cancer specialists who analyzed and discussed this new data. There is growing recognition of the value of serum thyroglobulin (Tg) as part of routine surveillance. An undetectable serum Tg measured during thyroid hormone suppression of TSH (THST) is often misleading. Eight studies show that 21% of 784 patients who had no clinical evidence of tumor with baseline serum Tg levels usually below 1 μg/liter during THST had, in response to recombinant human TSH (rhTSH), a rise in serum Tg to more than 2 μg/liter. When this happened, 36% of the patients were found to have metastases (36% at distant sites) that were identified in 91% by an rhTSH-stimulated Tg above 2 μg/liter. Diagnostic whole body scanning, after either rhTSH or thyroid hormone withdrawal, identified only 19% of the cases of metastases. Ten studies comprising 1599 patients demonstrate that a TSH-stimulated Tg test using a Tg cutoff of 2 μg/liter (either after thyroid hormone withdrawal or 72 h after rhTSH) is sufficiently sensitive to be used as the principal test in the follow-up management of low-risk patients with DTC and that the routine use of diagnostic whole body scanning in follow-up should be discouraged. On the basis of the foregoing, we propose a surveillance guideline using TSH-stimulated Tg levels for patients who have undergone total or near-total thyroidectomy and 131I ablation for DTC and have no clinical evidence of residual tumor with a serum Tg below 1 μg/liter during THST.

scholarly journals Compliance with follow-up and the informative value of diagnostic whole-body scan in patients with differentiated thyroid carcinoma given recombinant human TSH

2004 ◽  
Vol 150 (3) ◽  
pp. 285-290 ◽  
Author(s):  
O Cohen ◽  
S Dabhi ◽  
A Karasik ◽  
S Zila Zwas
Keyword(s):  
Thyroid Hormone ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Stimulating Hormone ◽  
Whole Body ◽  
Human Thyroid ◽  
Whole Body Scan ◽  
Body Scan ◽  
Thyroid Hormone Withdrawal ◽  
Tertiary Referral Center

OBJECTIVE: Protocols for monitoring patients with differentiated thyroid cancer (DTC) include measurement of serum Tg and, for most patients, whole-body scan (WBS) with low radioiodine activities ('diagnostic' WBS). Recently, recombinant human thyroid-stimulating hormone (rhTSH) has become available to provide the TSH stimulation necessary for these procedures, whilst avoiding thyroid hormone withdrawal and hypothyroid complications. In addition, the inclusion of diagnostic WBS in DTC follow-up has recently become controversial. We have assessed the compliance with withdrawal-aided monitoring and the informative value of diagnostic WBS in consecutive tertiary referral center patients. DESIGN: Forty-eight patients received rhTSH (0.9 mg) in two consecutive daily injections, with radioiodine administration 24 h, diagnostic WBS 48 h, and serum Tg testing prior to and 72 h later. METHODS: Compliance with withdrawal-aided monitoring was assessed with a questionnaire provided by the referring physician, patient record analysis, and patient interview. The informative value of diagnostic WBS was assessed by comparing findings against serum Tg measurements in light of physical and other radiological examinations. RESULTS: Forty of the forty-eight patients were female, the mean age was 43.9 years and the median follow-up from diagnosis was 4.5 years (range 1-19 years). Twenty-seven (56%) patients were compliant and 12 (25%) were non-compliant; compliance was not known in nine. Of 17 patients with clinically suspicious or significant findings on any available modality, four had uptake outside the thyroid bed on WBS but stimulated Tg <2.5 ng/ml on immunometric assay, while five had a negative WBS with serum Tg >2.5 ng/ml. CONCLUSIONS: Thyroid hormone withdrawal substantially impairs, and rhTSH administration substantially promotes, compliance with DTC monitoring. rhTSH-aided WBS is informative and should be included in the follow-up of unselected patients with DTC.

How to deal with undetectable and low measurable serum thyroglobulin levels in the follow-up of patients with differentiated thyroid carcinoma?

1985 ◽  
Vol 110 (4) ◽  
pp. 487-492 ◽  
Author(s):  
Matti Välimäki ◽  
Bror-Axel Lamberg
Keyword(s):  
Thyroid Carcinoma ◽  
Neck Region ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
Cancer Tissue ◽  
Serum Thyroglobulin ◽  
Before And After ◽  
Measurable Serum

Abstract. Serum thyroglobulin (Tg) was measured in 52 patients 3 months to 15 years (mean 5.3 years) after thyroidectomy with or without subsequent radioablation for differentiated thyroid carcinoma, before and after the interruption of suppressive thyroxine (T4) replacement therapy for 5 weeks. Whole body scintigraphy was carried out at the end of the T4 withdrawal period. Serum Tg was undetectable (< 3 μg/l) in 38 patients on T4 therapy, in 18 the scintigraphy showed a minimal accumulation in the neck region and in 20 no uptake anywhere after withdrawal of T4. In the former group Tg rose in 10 patients to 4–21 μg/l when off T4 which seemed to correspond to the normal tissue left in situ, in the latter group Tg rose only in 2 patients to 5 and 21 μg/l, respectively. Two patients out of 14 with detectable Tg on T4 had pulmonary metastases as uncovered by whole body scintigraphy (in one of them Tg rose from 12 μg/l on T4 to 1200 μg/l off T4) and 6 patients were suspected for having recidual cancer tissue (2 patients had a negative scintigraphy) because the Tg rose (66– 215 μg/l) over the upper limit of the reference range (< 50 μg/l) after T4 withdrawal. In conclusion, in the follow-up of patients with differentiated thyroid carcinoma no routine scans are needed as long as serum Tg remains undetectable but further examinations are shortly warranted when detectable Tg is obtained during T4 suppression.

scholarly journals Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin

2003 ◽  
pp. 589-596 ◽  
Author(s):  
KM van Tol ◽  
PL Jager ◽  
EG de Vries ◽  
DA Piers ◽  
HM Boezen ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Tumor Location ◽  
Differentiated Thyroid Carcinoma ◽  
Post Treatment ◽  
Whole Body ◽  
High Dose ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal ◽  
Iodine Treatment

BACKGROUND: Management of patients with differentiated thyroid carcinoma with negative diagnostic radioiodide scanning and increased serum thyroglobulin (Tg) concentrations is a widely debated problem. High-dose iodine-131 treatment of patients who have a negative (131)I diagnostic whole-body scan (WBS) is advocated. However, the therapeutic benefit of this "blind" treatment is not clear. OBJECTIVE: To investigate the course of serum Tg during thyroid hormone suppression therapy (Tg-on) and clinical outcome in patients with negative diagnostic (131)I scanning and increased serum Tg concentrations during thyroid hormone withdrawal (Tg-off), after treatment with high-dose (131)I. DESIGN: Retrospective single-center study. METHODS: Fifty-six patients were treated with a blind therapeutic dose of 150 mCi (131)I. Median follow-up from this treatment until the end of observation was 4.2 Years (range 0.5-13.5 Years). RESULTS: The post-treatment WBS revealed (131)I uptake in 28 patients, but none in the remaining 28 patients. In this study the Tg-on values did not change after treatment in either the positive or the negative post-treatment WBS group. During follow-up, 18 of the 28 patients with a positive post-treatment WBS achieved complete remission, compared with 10 of the 28 patients with a negative post-treatment WBS. Nine patients in the negative group died, but no patients died in the positive post-treatment group (P=0.001). CONCLUSIONS: High-dose iodine treatment in diagnostically negative patients who have a negative post-treatment scan seems to confer no additional value for tumor reduction and survival. In patients with a positive post-treatment scan, high-dose iodine treatment can be used as a diagnostic tool to identify tumor location, and a therapeutic effect may be present in individual cases.

scholarly journals Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer

2003 ◽  
pp. 19-24 ◽  
Author(s):  
M Torlontano ◽  
U Crocetti ◽  
L D'Aloiso ◽  
N Bonfitto ◽  
A Di Giorgio ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Thyroid Hormone ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Whole Body Scan ◽  
Serum Thyroglobulin ◽  
Risk Patients ◽  
Node Metastases

OBJECTIVE: The 'standard' postoperative follow-up of patients with differentiated thyroid cancer (DTC) has been based upon serum thyroglobulin (Tg) measurement and (131)I whole body scan ((131)I-WBS) after thyroid hormone (T(4)) treatment withdrawal. However, (131)I-WBS sensitivity has been reported to be low. Thyroid hormone withdrawal, often associated with hypothyroidism-related side effects, may now be replaced by recombinant human thyroid stimulating hormone (rhTSH). The aim of our study was to evaluate the diagnostic accuracy of (131)I-WBS and serum Tg measurement obtained after rhTSH stimulation and of neck ultrasonography in the first follow-up of DTC patients. DESIGN: Ninety-nine consecutive patients previously treated with total thyroidectomy and (131)I ablation, with no uptake outside the thyroid bed on the post-ablative (131)I-WBS (low-risk patients) were enrolled. METHODS: Measurement of serum Tg and (131)I-WBS after rhTSH stimulation, and ultrasound examination (US) of the neck. RESULTS: rhTSH-stimulated Tg was <or=1 ng/ml in 78 patients (Tg-) and >1 ng/ml (Tg+) in 21 patients, including 6 patients with Tg levels >5 ng/ml. (131)I-WBS was negative for persistent or recurrent disease in all patients (i.e. sensitivity = 0%). US identified lymph-node metastases (confirmed at surgery) in 4/6 (67%) patients with stimulated Tg levels >5 ng/ml, in 2/15 (13%) with Tg>1<5 ng/ml, and in 2/78 (3%) who were Tg-negative. CONCLUSIONS: (i) diagnostic (131)I-WBS performed after rhTSH stimulation is useless in the first follow-up of DTC patients; (ii) US may identify lymph node metastases even in patients with low or undetectable serum Tg levels.

scholarly journals Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

2020 ◽  
Vol 182 (5) ◽  
pp. D1-D16 ◽  
Author(s):  
Livia Lamartina ◽  
Daria Handkiewicz-Junak
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Differentiated Thyroid Carcinoma ◽  
Low Risk ◽  
Response To Treatment ◽  
Early Discontinuation ◽  
Risk Patients ◽  
Low Prevalence ◽  
Time Point

Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

scholarly journals Neck Lymph Node Metastasis Detection in Patients with Differentiated Thyroid Carcinoma (DTC) in Long-Term Follow-up: a ¹³¹I-SPECT/CT Study

2019 ◽  
Author(s):  
Angela Spanu ◽  
Susanna Nuvoli ◽  
Andrea Marongiu ◽  
Ilaria Gelo ◽  
Luciana Mele ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Carcinoma ◽  
Low Risk ◽  
Whole Body ◽  
Neck Lymph Node ◽  
Incremental Value ◽  
Long Term Follow Up

Abstract Background: The prognostic importance of neck lymph node (LN) metastases in differentiated thyroid carcinoma (DTC) is controversial even if their presence at surgery often correlates with tumor recurrences that it is mandatory to identify. To this purpose, in the present study, we used 131 I-SPECT/CT as diagnostic imaging procedure. Methods: We retrospectively evaluated 224 consecutive DTC patients already submitted to total thyroidectomy and radioiodine therapy, all of them with ascertained neck radioiodine-avid foci at ¹³¹I-SPECT/CT during long-term follow-up; at surgery, 62 patients were classified at high risk (H), 64 at low risk (L), 98 at very low risk. All patients underwent ¹³¹I-Whole body scan (WBS) followed by SPECT/CT. Result: In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at WBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci SPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter it pinpointed 26 LN metastases, 18 residues and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN metastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while WBS evidenced 34 in 25 cases. All 13 VL patients,T1aN0M0, 5 of whom with LN near sub-mandibular glands, had thyroglobulin undetectable or <2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5 % of patients, a more correct patient classification changing therapeutic approach in 30.3 % of cases and identified WBS false positive findings in 8% of cases. Conclusion: ¹³¹I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in long-term follow-up, improving WBS performance. SPECT/CT routine use is suggested, its role being particularly significant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low thyroglobulin levels.

scholarly journals Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients

2009 ◽  
Vol 160 (3) ◽  
pp. 431-436 ◽  
Author(s):  
M Chianelli ◽  
V Todino ◽  
F M Graziano ◽  
C Panunzi ◽  
D Pace ◽  
...  
Keyword(s):  
Ablation Rate ◽  
Low Risk ◽  
Whole Body ◽  
Radioiodine Uptake ◽  
Ablation Therapy ◽  
Risk Patients ◽  
Group A ◽  
Group B ◽  
Low Activity

Objective(a) To compare the efficacy of low-activity (2 GBq; 54 mCi) 131I ablation using l-thyroxine withdrawal or rhTSH stimulation, and (b) to assess the influence of thyroid remnants volume on the ablation rate.DesignPatients underwent neck ultrasound, 131I neck scintigraphy and radioiodine uptake. Post-therapy whole body scan (WBS) was acquired after 4–6 days. Ablation was assessed after 6–12 months by WBS, Tg and TgAb following l-thyroxine withdrawal.MethodsGroup A: preparation by L-T4 withdrawal (37 days); 21 patients received 131I (2.02±0.22 GBq; 54.6±5.9 mCi) and on the day of treatment, TSH, Tg, TgAb were measured; Group B: stimulation by rhTSH; 21 patients received 131I (1.97±0.18 GBq; 53.2±4.9 mCi) 24 h after the second injection of rhTSH (0.9 mg) and TSH, Tg and TgAb were measured after 2 days.ResultsAt follow-up, 90.0% of patients from group A and 85.0% of patients from group B had Tg levels <1 ng/ml; no uptake was observed in 95.2% and in 90.5% of patients from group A or B respectively, with no statistical differences for both ablation criteria. Before 131I treatment, small thyroid remnants (<1 ml) were detected by US in <25% of all patients.ConclusionsThe use of rhTSH for the preparation of low-risk patients to ablation therapy with low activities of 131I (2 GBq; 54 mCi) is safe and effective and avoids hypothyroidism. The presence of thyroid remnants smaller than 1 ml at US evaluation had no effect on the ablation rate.

Sign in / Sign up

Export Citation Format

Share Document