Role of Preablative-Stimulated Thyroglobulin in Prediction of Nodal and Distant Metastasis on Iodine Whole-body Scan.

Sir,

We read with interest the article “Role of Preablative-Stimulated Thyroglobulin in Prediction of Nodal and Distant Metastasis on Iodine Whole-Body Scan” by Prabhu et al.[1] We would like to congratulate the authors on their experience of preablative-stimulated thyroglobulin in reliably excluding metastatic disease in differentiated thyroid cancer (DTC). We would agree with this finding of ps-Tg value in the absence of anti-Tg antibodies <1 ng/ml excluding metastasis and helping in tailoring radioiodine ablation routinely with ps-Tg >5 mg/ml and individualizing ps-Tg between 1 and 5 mg/ml. One of the most important factors in the management of DTC is the management of central neck nodes. As it is said the surgical battle of DTC is won or lost in the central comportment. The central compartment lymph node dissection (CCLND) in DTC has a crucial role, especially in prognosis and also recurrence.[234] Reoperative thyroid surgeries are fraught with increased incidence of recurrent laryngeal nerve injury and hypoparathyroidism. We have few queries which may interest future readers.

Did the authors perform CCLND (prophylactic and therapeutic) and what proportion of these patients had recurrence? Did any of the patients have foci of poorly differentiated carcinoma? How many patients had metastasis at the time of presentation? Did any of these patients have Contrast Enhanced computed tomography scan as preoperative imaging? Did any of these patients have raising Tg level with no finding on iodine whole-body scan which necessitated positron-emission tomography scan?

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