title: Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden.
abstract: OBJECTIVE
  In patients with differentiated thyroid cancer (DTC), the stimulated serum thyroglobulin (Tg) level at radioiodine ablation is a known predictive factor of persistent disease. This prognostic value is based on data obtained after thyroid hormone withdrawal (THW), but little is known about this prognostic value after recombinant human TSH (rhTSH) stimulation and about the relationship between the stimulated Tg level and the burden of persistent tumor. We aimed to assess the impact of both radioiodine preparation modalities and persistent tumor burden on stimulated Tg levels.
  
  
  METHODS
  The stimulated Tg level was measured at radioablation in 308 consecutive DTC patients without serum Tg antibodies. Of these, 123 (40%) were prepared with rhTSH and 185 with THW. Post-ablation scintigraphy included total-body scan and neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT). During a mean follow-up of 43 months, persistent/recurrent disease (PRD) was found in 56 patients (18%). PRD was considered structural in the presence of lesions >1 cm and nonstructural otherwise.
  
  
  RESULTS
  Nonstructural PRD was more frequent in the rhTSH group than in the THW group (64 vs 26%, P=0.01). Stimulated Tg levels were lower after rhTSH than after THW in patients with (13.5 vs 99.5 ng/ml, P<0.01) and without (1.2 vs 3.2 ng/ml, P<0.001) PRD. Also, Tg levels were lower in nonstructural disease than in structural disease in both rhTSH (3.8 vs 127.0 ng/ml, P<0.01) and THW (13.0 vs 143.5 ng/ml, P<0.0001) patients. The best Tg cutoff to predict PRD was 2.8 in rhTSH and 28 ng/ml in THW patients.
  
  
  CONCLUSIONS
  Both radioiodine preparation modalities and the burden of persistent tumor affect the stimulated Tg level at ablation.
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France r.ciappuccini@baclesse.fr.
authors.forename: Renaud
authors.initials: R
authors.lastname: Ciappuccini
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, FranceDepartments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Hardouin
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Heutte
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vaur
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Elske
authors.initials: E
authors.lastname: Quak
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Rame
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: David
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: de Raucourt
authors.affiliation: Departments of Nuclear Medicine and Thyroid UnitCentre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, FranceDepartment of EndocrinologyCentre Hospitalo-Universitaire, Caen, FranceU1086 INSERM-UCBN Cancers et PréventionsCaen, FranceDepartments of BiologyHead and Neck SurgeryCentre François Baclesse, Caen, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bardet
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000532:radiotherapy; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013375:Substance Withdrawal Syndrome; D013954:Thyroglobulin / Q000097:blood*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D013972:Thyrotropin; D057073:Thyrotropin Alfa / Q000627:therapeutic use*; D013974:Thyroxine / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000009:adverse effects; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes; D057073:Thyrotropin Alfa; D014284:Triiodothyronine; D013972:Thyrotropin; D013954:Thyroglobulin; D013974:Thyroxine