Recombinant human thyrotropin stimulation of thyroglobulin in the follow-up of patients with stage I or II differentiated thyroid carcinoma.
OBJECTIVE
To present an approach for follow-up of low-risk patients who have undergone treatment for differentiated thyroid carcinoma.


METHODS
We review our experience with monitoring of 167 patients who had undergone near-total thyroidectomy for stage I or II thyroid carcinoma and were receiving levothyroxine and discuss the advantages and disadvantages of various tests for detection of recurrent disease in this setting.


RESULTS
Almost 200,000 patients who have been treated for thyroid cancer live in the United States and require monitoring for possible recurrence of their disease. Most of these patients had stage I or II well-differentiated cancer. A cost-efficient method of follow-up for these low-risk patients is needed that relies on measurement of serum thyroglobulin (Tg) rather than expensive isotope imaging procedures. The availability of recombinant human thyrotropin (thyroid-stimulating hormone) (rhTSH) allows the evaluation of Tg dynamics and provides another method, along with ultrasonography, to monitor these patients. Among our 167 patients, 10 had Tg measurements of 2.5 to 5.0 ng/mL and were thought to be at risk for recurrent cancer. Ultrasonography of the neck revealed no suspicious lymph nodes. Tg response to rhTSH stimulation disclosed that two of these patients had an exaggerated increase in Tg level, compatible with persistent or recurrent cancer.


CONCLUSIONS
Although rhTSH stimulation testing has not yet become established in clinical practice, the finding of an exaggerated Tg response to rhTSH in patients with previously treated thyroid cancer seems to be an early indication of recurrent disease.
Baskin
H J
HJ
Florida Thyroid and Endocrine Clinic, 2921 North Orange Ave., Orlando, FL 32804, USA.
Atwood
T M
TM
Holcomb
L P
LP
D018263:Adenocarcinoma, Follicular / Q000097:blood* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000097:blood* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011994:Recombinant Proteins; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin; D014463:Ultrasonography
D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin