PURPOSE: Recurrences are frequent in thyroid cancer patients and long-term follow-up is therefore necessary. We evaluated the yield of rhTSH stimulation in three groups of patients, classified according to the UICC/TNM risk stratification and the results of first follow-up testing. METHODS: The study population comprised 129 patients referred for rhTSH testing. All had undergone first follow-up testing after thyroid hormone withdrawal (off-T4) within 1 year of 131I ablation. Negative first follow-up testing was defined as Tg <2 ng/ml and no neck uptake on 131I diagnostic whole-body scan. Seventy-five patients had stage I thyroid cancer and negative first follow-up testing (group A), 19 had stage I disease and positive first follow-up testing (group B), and 35 had stage II-IV disease (group C). RhTSH stimulation was performed an average of 6 years after first follow-up testing. RESULTS: 131I diagnostic scanning after rhTSH was negative in all 75 group A patients. Only one group A patient had detectable Tg after rhTSH injection (1.5 ng/ml), but Tg had also been detected at baseline in this patient (1.45 ng/ml). Given the absence of a response to stimulation, suggesting an interference, Tg was reassessed with a different technique and proved to be undetectable (<0.1 ng/ml). Stimulation with rhTSH in group B showed residual Tg in seven patients and residual 131I uptake in the thyroid bed in two patients, but none of these patients had signs of disease progression. Five group C patients (14%) had a positive rhTSH test result, and this was suggestive of disease progression in at least two cases. CONCLUSION: The first follow-up testing is essential for prognostic classification after 131I ablation of thyroid cancer. In stage I patients, undetectable Tg and negative 131I scan 1 year after ablation define a large population of subjects who have a very low risk of recurrence and who do not require further stimulation tests. In contrast, periodic rhTSH stimulation tests appear useful in higher-risk patients.
PURPOSE: Recurrences are frequent in thyroid cancerpatients and long-term follow-up is therefore necessary. We evaluated the yield of rhTSH stimulation in three groups of patients, classified according to the UICC/TNM risk stratification and the results of first follow-up testing. METHODS: The study population comprised 129 patients referred for rhTSH testing. All had undergone first follow-up testing after thyroid hormone withdrawal (off-T4) within 1 year of 131I ablation. Negative first follow-up testing was defined as Tg <2 ng/ml and no neck uptake on 131I diagnostic whole-body scan. Seventy-five patients had stage I thyroid cancer and negative first follow-up testing (group A), 19 had stage I disease and positive first follow-up testing (group B), and 35 had stage II-IV disease (group C). RhTSH stimulation was performed an average of 6 years after first follow-up testing. RESULTS:131I diagnostic scanning after rhTSH was negative in all 75 group A patients. Only one group A patient had detectable Tg after rhTSH injection (1.5 ng/ml), but Tg had also been detected at baseline in this patient (1.45 ng/ml). Given the absence of a response to stimulation, suggesting an interference, Tg was reassessed with a different technique and proved to be undetectable (<0.1 ng/ml). Stimulation with rhTSH in group B showed residual Tg in seven patients and residual 131I uptake in the thyroid bed in two patients, but none of these patients had signs of disease progression. Five group C patients (14%) had a positive rhTSH test result, and this was suggestive of disease progression in at least two cases. CONCLUSION: The first follow-up testing is essential for prognostic classification after 131I ablation of thyroid cancer. In stage I patients, undetectable Tg and negative 131I scan 1 year after ablation define a large population of subjects who have a very low risk of recurrence and who do not require further stimulation tests. In contrast, periodic rhTSH stimulation tests appear useful in higher-risk patients.
Authors: Pamela R Schroeder; Bryan R Haugen; Furio Pacini; Christoph Reiners; Martin Schlumberger; Steven I Sherman; David S Cooper; Kathryn G Schuff; Lewis E Braverman; Monica C Skarulis; Terry F Davies; Ernest L Mazzaferri; Gilbert H Daniels; Douglas S Ross; Markus Luster; Mary H Samuels; Bruce D Weintraub; E Chester Ridgway; Paul W Ladenson Journal: J Clin Endocrinol Metab Date: 2006-01-04 Impact factor: 5.958
Authors: P W Ladenson; L E Braverman; E L Mazzaferri; F Brucker-Davis; D S Cooper; J R Garber; F E Wondisford; T F Davies; L J DeGroot; G H Daniels; D S Ross; B D Weintraub Journal: N Engl J Med Date: 1997-09-25 Impact factor: 91.245
Authors: Alessia David; Annabella Blotta; Roberta Rossi; Maria Chiara Zatelli; Marta Bondanelli; Elio Roti; Lewis E Braverman; Luciano Busutti; Ettore C degli Uberti Journal: Thyroid Date: 2005-03 Impact factor: 6.568
Authors: Martin Schlumberger; Gertrud Berg; Ohad Cohen; Leonidas Duntas; François Jamar; Barbara Jarzab; Eduard Limbert; Peter Lind; Furio Pacini; Christoph Reiners; Franco Sánchez Franco; Anthony Toft; Wilmar M Wiersinga Journal: Eur J Endocrinol Date: 2004-02 Impact factor: 6.664
Authors: Joanna Klubo-Gwiezdzinska; Kenneth D Burman; Douglas Van Nostrand; Leonard Wartofsky Journal: Clin Endocrinol (Oxf) Date: 2011-01 Impact factor: 3.478
Authors: Adrienne C M Persoon; Pieter L Jager; Wim J Sluiter; John T M Plukker; Bruce H R Wolffenbuttel; Thera P Links Journal: PLoS One Date: 2007-08-29 Impact factor: 3.240