Clinical value of different responses of serum thyroglobulin to recombinant human thyrotropin in the follow-up of patients with differentiated thyroid carcinoma.
In the present study, we examined the clinical value of a differential response of thyroglobulin (Tg) concentration after recombinant human thyrotropin (rhTSH) stimulation (rhTSH Tg testing) and its correlation with (131)I uptake and whole body scanning (rhTSH-WBS) in 104 patients who had previously undergone near total thyroidectomy and (131)I ablation for differentiated thyroid carcinoma (DTC). RhTSH Tg testing was considered negative for rhTSH-Tg < 0.9 ng/mL, low positive for rhTSH-Tg of 1-5 ng/mL and high positive for rhTSHTg > 5 ng/mL. RhTSH Tg testing was negative in 70 patients, one of whom had a lymph-node metastasis, but no (131)I uptake. Seven patients had low positive rhTSH Tg testing and no (131)I uptake, but two of these patients had cervical lymph-node metastases. Twenty-seven patients had high positive rhTSH Tg testing and (131)I uptake was detected in lung, bone, or mediastinum in 11. Imaging techniques (CT, MRI, FDG-PET) documented metastatic disease in 22. In conclusion, our results suggest that any rise in rhTSH-Tg, even at low level, should raise the suspicion of persistent or recurrent DTC. Patients with rhTSH-Tg at high level should be carefully evaluated, since DTC persistence is highly probable. TSH-WBS provides little adjunctive information.
David
Alessia
A
Section of Endocrinology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, 44100 Ferrara, Italy.
Blotta
Annabella
A
Rossi
Roberta
R
Zatelli
Maria Chiara
MC
Bondanelli
Marta
M
Roti
Elio
E
Braverman
Lewis E
LE
Busutti
Luciano
L
degli Uberti
Ettore C
EC
D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy*; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications / Q000188:drug therapy; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000627:therapeutic use; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000627:therapeutic use*
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin