| Incidence and Implications of Negative Serum Thyroglobulin but Positive I-131 Whole Body Scans in Patients With Well Differentiated Thyroid Cancer prepared with rhTSH or Thyroid Hormone Withdrawal. | |
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MedLine Citation:
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PMID: 22050475 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Aims: To evaluate the incidence and clinical implications of a positive whole body I-131 scan but negative stimulated serum Tg/TgAb level following an ablative or diagnostic I-131 dose in patients with well differentiated thyroid cancer and whether there is a difference in incidence if prepared with thyroid hormone withdrawal compared to rhTSH stimulation. Methods: I-131 scan findings, serum Tg/TgAb levels, TNM stage and method of thyroid tissue stimulation in 193 consecutive patients (138F, 55M) with well differentiated thyroid cancer undergoing post operative ablative I-131 therapy and 121 consecutive (94F, 27M) patients undergoing diagnostic I-131 surveillance scans were retrospectively reviewed. Comparisons of proportions were performed using Chi-square tests. Clinical, biochemical and I-131 scan follow up data were obtained for each patient cohort. Results: 39/193 (20.2%) post ablative I-131 and 10/121 (8.3%) diagnostic I-131 patients had negative stimulated serum Tg/TgAb levels but positive I-131 scans for residual thyroid tissue. Nine (4.7%) of the post-ablative patients had I-131 uptake in the lateral neck suspicious for loco-regional metastatic disease. In the post ablative I-131 group, 38/169 (22.5%) prepared with rhTSH compared to 1/24 (4.2%) prepared with thyroid hormone withdrawal were Tg/TgAb negative but I-131 scan positive (p=0.04). Follow up of 21/39 post ablative I-131 patients with negative Tg/TgAb but positive I-131 scans confirmed a significant proportion of patients (4/21) (19.1%), remained Tg/TgAb negative / I-131 scan positive, some of whom had higher risk disease at original diagnosis (2/4) (50%). Conclusions: Our study confirms that in the setting of I-131 ablation therapy or diagnostic I-131 scanning, a significant proportion of patients (20.2% and 8.3% respectively) have residual benign or malignant thyroid tissue on whole body scanning despite a negative stimulated serum Tg level. Whether such patients who would otherwise be missed as having residual thyroid tissue on serum Tg testing alone have a worse clinical outcome remains uncertain. Our findings do however suggest performing both stimulated serum Tg/TgAb levels and I-131 scans for follow up of patients with higher risk thyroid cancer may be important. There may also be a slightly higher incidence of this phenomenon in patients prepared with rhTSH rather than by thyroxine withdrawal. |
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Authors:
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Martin H Cherk; Peter Francis; Duncan J Topliss; Michael Bailey; Victor Kalff |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-2 |
Journal Detail:
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Title: Clinical endocrinology Volume: - ISSN: 1365-2265 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0346653 Medline TA: Clin Endocrinol (Oxf) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Blackwell Publishing Ltd. |
Affiliation:
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Department of Nuclear Medicine Department of Endocrinology and Diabetes Department of Medicine Monash University Monash University Department of Epidemiology & Preventive Medicine Alfred Hospital, Commercial Road, Melbourne Victoria 3004, AUSTRALIA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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