title: Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Unit of Endocrinology, Scientific Institute 'Casa Sollievo della Sofferenza', 71013 San Giovanni Rotondo, Foggia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Umberto
authors.initials: U
authors.lastname: Crocetti
authors.forename: Leonardo
authors.initials: L
authors.lastname: D'Aloiso
authors.forename: Nazario
authors.initials: N
authors.lastname: Bonfitto
authors.forename: Anna
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: Sergio
authors.initials: S
authors.lastname: Modoni
authors.forename: Guido
authors.initials: G
authors.lastname: Valle
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Frusciante
authors.forename: Michele
authors.initials: M
authors.lastname: Bisceglia
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Trischitta
mesh_terms: D000328:Adult; D000368:Aged; D018265:Carcinoma, Papillary, Follicular / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013972:Thyrotropin / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin