BACKGROUND: Circulating human thyroglobulin (TG) measurement has a pivotal role in the management of patients affected by differentiated thyroid cancer (DTC). Undetectable thyrotropin (TSH)-stimulated serum TG after thyroid ablation (i.e., thyroidectomy and radioiodine) implies the absence of residual or relapsing DTC. Recently, high-cost recombinant human TSH (rhTSH) was proposed for TG stimulation to avoid uncomfortable thyroxine (T(4)) withdrawal. However, only a small fraction of relapsing DTC patients showed undetectable TG under T(4) treatment (onT(4)-TG) by high-sensitivity assays. The present study was undertaken to compare onT(4)-TG with the rhTSH-stimulated TG assay (rhTSH-TG), (131)I scanning and neck ultrasound (US) with fine-needle aspiration biopsy. METHODS: We enrolled 117 patients with histologically proven DTC treated by total thyroidectomy and radioiodine. Inclusion criteria were: complete tumour excision, no radioiodine uptake outside of the thyroid bed at post-treatment scan and undetectable onT(4)-TG 3 months after primary treatment. At 1 year after radioiodine treatment, all patients underwent onT(4)-TG assay, rhTSH-stimulated TG assay, (131)I scanning and neck US. Based on histology, clinical data and long-term follow-up, persistent/relapsing disease was confirmed in 14 patients. RESULTS: onT(4)- and rhTSH-TG were positive in 10 and 12 patients, respectively and two patients converted from undetectable to detectable TG after rhTSH administration. Neck US was positive in 10 patients and a combination of US with onT(4)- and rhTSH-TG assays showed positivity in 13 and 14 out 14 patients, respectively. A radioiodine scan was positive in six patients, all with positive onT(4)- and rhTSH-TG levels. Globally, the negative predictive value of the onT(4)- and rhTSH-TG assays was 99% and 100%, respectively, and 104 rhTSH stimulations had to be performed to detect one local recurrence with negative onT(4)-TG. CONCLUSIONS: Our preliminary data need further confirmation on larger groups of patients, but seem to indicate that onT(4)-TG assay by a high-sensitivity method combined with neck US may avoid rhTSH stimulation in low-risk DTC patients after surgery and radioiodine thyroid ablation.
BACKGROUND: Circulating humanthyroglobulin (TG) measurement has a pivotal role in the management of patients affected by differentiated thyroid cancer (DTC). Undetectable thyrotropin (TSH)-stimulated serum TG after thyroid ablation (i.e., thyroidectomy and radioiodine) implies the absence of residual or relapsing DTC. Recently, high-cost recombinant human TSH (rhTSH) was proposed for TG stimulation to avoid uncomfortable thyroxine (T(4)) withdrawal. However, only a small fraction of relapsing DTCpatients showed undetectable TG under T(4) treatment (onT(4)-TG) by high-sensitivity assays. The present study was undertaken to compare onT(4)-TG with the rhTSH-stimulated TG assay (rhTSH-TG), (131)I scanning and neck ultrasound (US) with fine-needle aspiration biopsy. METHODS: We enrolled 117 patients with histologically proven DTC treated by total thyroidectomy and radioiodine. Inclusion criteria were: complete tumour excision, no radioiodine uptake outside of the thyroid bed at post-treatment scan and undetectable onT(4)-TG 3 months after primary treatment. At 1 year after radioiodine treatment, all patients underwent onT(4)-TG assay, rhTSH-stimulated TG assay, (131)I scanning and neck US. Based on histology, clinical data and long-term follow-up, persistent/relapsing disease was confirmed in 14 patients. RESULTS: onT(4)- and rhTSH-TG were positive in 10 and 12 patients, respectively and two patients converted from undetectable to detectable TG after rhTSH administration. Neck US was positive in 10 patients and a combination of US with onT(4)- and rhTSH-TG assays showed positivity in 13 and 14 out 14 patients, respectively. A radioiodine scan was positive in six patients, all with positive onT(4)- and rhTSH-TG levels. Globally, the negative predictive value of the onT(4)- and rhTSH-TG assays was 99% and 100%, respectively, and 104 rhTSH stimulations had to be performed to detect one local recurrence with negative onT(4)-TG. CONCLUSIONS: Our preliminary data need further confirmation on larger groups of patients, but seem to indicate that onT(4)-TG assay by a high-sensitivity method combined with neck US may avoid rhTSH stimulation in low-risk DTCpatients after surgery and radioiodine thyroid ablation.
Authors: Cláudia C D Nakabashi; Teresa S Kasamatsu; Felipe Crispim; Claudia A Yamazaki; Cléber P Camacho; Danielle M Andreoni; Rosalia P Padovani; Elza S Ikejiri; Maria C O M Mamone; Flávia C Aldighieri; Jairo Wagner; Jairo T Hidal; José G H Vieira; Rosa P M Biscolla; Rui M B Maciel Journal: Eur Thyroid J Date: 2014-03-12
Authors: A Polachek; D Hirsch; G Tzvetov; S Grozinsky-Glasberg; I Slutski; J Singer; R Weinstein; I Shimon; C A Benbassat Journal: J Endocrinol Invest Date: 2011-05-30 Impact factor: 4.256
Authors: A Piccardo; F Arecco; S Morbelli; P Bianchi; F Barbera; M Finessi; S Corvisieri; E Pestarino; L Foppiani; G Villavecchia; M Cabria; F Orlandi Journal: J Endocrinol Invest Date: 2009-07-28 Impact factor: 4.256