title: Treatment of iodine-negative thyroglobulin-positive thyroid cancer: differences in outcome in patients with macrometastases and patients with micrometastases.
abstract: OBJECTIVE
  During the follow-up of patients with well-differentiated thyroid carcinoma, some patients have elevated serum thyroglobulin (Tg) levels without any evidence of radioiodine accumulation on diagnostic whole-body scan (d-WBS). The treatment strategy in these patients is considered a clinical dilemma, with some groups recommending blind use of high-dose radioiodine therapy. The aim of this study was to evaluate whether or not high doses of radioiodine have beneficial effects in these patients.
  
  
  METHODS
  Twenty-seven patients were included in the study. All patients had negative d-WBS and elevated levels of Tg. All received high doses of radioiodine. The mean follow-up period was 6.3+/-5.8 years. There were 11 patients with macrometastases and 16 with micrometastases.
  
  
  RESULTS
  Post-treatment WBS revealed radioiodine accumulation in 19 of 24 (79%) patients. Serum Tg levels were decreased in 8 of 16 (50%) patients. Among patients with micrometastases, five out of seven (71%) demonstrated a decrease in serum Tg levels. Among patients with macrometastases, three out of nine (33%) demonstrated a decrease in Tg values and three (33%) have died due to metastatic thyroid cancer.
  
  
  CONCLUSIONS
  Radioiodine treatment may have a beneficial therapeutic effect in patients who have elevated levels of serum Tg and negative d-WBS. This is especially true in those patients with micrometastases; in patients with macrometastases, a beneficial effect of this approach may be observed less frequently.
authors.affiliation: Department of Nuclear Medicine, Cerrahpaşa Medical Faculty, Istanbul University, 34303 Istanbul, Turkey. kabasaka@istanbul.edu.tr
authors.forename: Levent
authors.initials: L
authors.lastname: Kabasakal
authors.forename: Nalan Alan
authors.initials: NA
authors.lastname: Selçuk
authors.forename: Hojjet
authors.initials: H
authors.lastname: Shafipour
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ozmen
authors.forename: Cetin
authors.initials: C
authors.lastname: Onsel
authors.forename: Ilhami
authors.initials: I
authors.lastname: Uslu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013954:Thyroglobulin