Empiric high-dose 131-iodine therapy lacks efficacy for treated papillary thyroid cancer patients with detectable serum thyroglobulin, but negative cervical sonography and 18F-fluorodeoxyglucose positron emission tomography scan.
BACKGROUND
Some patients with elevated serum thyroglobulin (Tg) but a negative diagnostic whole body scan (WBS) after initial therapy for differentiated thyroid carcinoma may benefit from empirical radioactive iodine (RAI) therapy. However, previous studies enrolled patients with negative diagnostic WBS, regardless of neck ultrasonography (USG) and/or (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), which have become the preferred diagnostic procedures in such patients.


OBJECTIVE
The aim of this study was to evaluate the usefulness of empirical RAI therapy in patients with elevated stimulated Tg level and negative USG/FDG-PET findings after initial therapy for papillary thyroid carcinoma (PTC).


METHODS
This comparative study enrolled 39 patients with elevated stimulated Tg, negative diagnostic WBS, and negative USG/FDG-PET 1 yr after initial treatment. Empirical RAI therapy was performed in 14 patients (treatment group), whereas 25 patients were followed up without therapy (control group).


RESULTS
There was no significant between-group difference in basal clinicopathological parameters. None of the 14 patients in the treatment group showed iodine uptake on posttreatment WBS. Five of 14 patients (36%) in the treatment group and eight of 25 (32%) in the control group had recurrence during the median 37 months of follow-up (P = 0.99). Changes in serum stimulated Tg concentrations did not differ between the two groups.


CONCLUSIONS
Empirical RAI therapy and posttreatment WBS were not useful diagnostically or therapeutically in patients with positive serum stimulated Tg if such patients had negative USG and negative FDG-PET findings after initial treatment of PTC.
Kim
Won Gu
WG
Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. kimwb@amc.seoul.kr
Ryu
Jin-Sook
JS
Kim
Eui Young
EY
Lee
Jeong Hyun
JH
Baek
Jung Hwan
JH
Yoon
Jong Ho
JH
Hong
Suck Joon
SJ
Kim
Eun Sook
ES
Kim
Tae Yong
TY
Kim
Won Bae
WB
Shong
Young Kee
YK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000097:blood / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002648:Child; D004307:Dose-Response Relationship, Radiation; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012008:Recurrence; D018709:Statistics, Nonparametric; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D051598:Whole Body Imaging
D007457:Iodine Radioisotopes; D019788:Fluorodeoxyglucose F18; D013954:Thyroglobulin