title: Clinical determinants of fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)iodine whole body scans after (131)iodine therapy.
abstract: BACKGROUND
  A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative (131)Iodine ((131)I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells.
  
  
  METHODS
  Thirty-five patients with histologically proven DTC that have undergone total or near total thyroidectomy, and post (131)I radioactive iodine ablation therapy, were selected and prospectively analysed. The patients also had to show at least one negative whole body scan and Tg levels of 10 μg/L and above. The results of the FDG-Positron Emission Tomography/Computed Tomography (PET/CT) were then studied to determine the association and the predictors influencing the outcome by using univariable and multivariable analyses.
  
  
  RESULTS
  Out of the thirty-five patients, 60% of them (twenty-one) showed positive results and 40% (fourteen) showed negative. Age, gender, and type of histopathology (HPE) showed significant associations with the positive results of the FDG-PET/CT. The results also showed no correlations observed between the Tg levels and standardised uptake value (SUV)max in the DTC patients with positive disease findings in the FDG-PET/CT. The predictor for this study was age.
  
  
  CONCLUSIONS
  The prevalence of the conversion of differentiated to dedifferentiated thyroid cancer among patients with negative (131)I and elevated Tg was 60%, with age as the predictor. DTC patients aged 45 year-old and older were seven times more likely to have positive results of FDG-PET/CT imaging.
authors.affiliation: Department of Nuclear Medicine, Radiotherapy and Oncology, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia ; Advanced Medical and Dental Institute, Universiti Sains Malaysia, No 1-8, Persiaran Seksyen 4/1, Bandar Putra Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia.
authors.forename: Syed Ejaz
authors.initials: SE
authors.lastname: Shamim
authors.affiliation: Department of Nuclear Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia ; Department of Nuclear Medicine, Hospital Putrajaya, Jalan P9, Presint 7, 62250 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia.
authors.forename: Lee Boon
authors.initials: LB
authors.lastname: Nang
authors.affiliation: Advanced Medical and Dental Institute, Universiti Sains Malaysia, No 1-8, Persiaran Seksyen 4/1, Bandar Putra Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia.
authors.forename: Ibrahim Lutfi
authors.initials: IL
authors.lastname: Shuaib
authors.affiliation: Institute for Medical Research, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors.forename: Nor Asiah
authors.initials: NA
authors.lastname: Muhamad
keywords: fluorodeoxyglucose F18; iodine; positron-emission tomography; thyroglobulin; thyroid cancer; whole body scan