Document Detail

Thyroid cancer recurrence in patients clinically free of disease with undetectable or very low serum thyroglobulin values.
MedLine Citation:
PMID:  20843945     Owner:  NLM     Status:  MEDLINE    
DESIGN: This was a retrospective clinical study.
SETTING: The study was conducted at a university-based tertiary cancer hospital.
PATIENTS: One hundred seven patients had initial thyroid cancer surgery and subsequent remnant radioiodine ablation. Patients underwent recombinant human TSH (rhTSH)-mediated diagnostic whole-body scan and rhTSH-stimulated thyroglobulin (Tg) measurement before April 2001 if they had no antithyroglobulin antibodies, were clinically free of disease, and had one or more undetectable (≤0.5 ng/ml) or low (0.6-1 ng/ml) basal Tg measurements on levothyroxine. Patients were stratified according to their rhTSH-Tg responses: group 1, Tg 0.5 ng/ml or less (68 patients); group 2, Tg from 0.6 to 2.0 ng/ml (19 patients); and group 3, Tg greater than 2 ng/ml (20 patients).
MAIN OUTCOME MEASURES: Tumor recurrence was measured.
RESULTS: In group 1, two of 62 patients (3%) with follow-up recurred. In group 2, 63% converted to group 1, whereas two of 19 (11%) converted to group 3 and then recurred. Sixteen of the initial 20 group 3 patients (80%) recurred, including recurrence rates of 69 and 100% for those with an initial rhTSH-Tg greater than 2.0 ng/ml but 5.0 ng/ml or less, and 4.6 ng/ml or greater, respectively. One group 3 patient died of distant metastases. rhTSH-Tg more accurately predicted tumor recurrence than basal Tg. An rhTSH-Tg threshold of 2.5 ng/ml or greater optimally predicted future recurrence with sensitivity, specificity, and negative and positive predictive values of 80, 97, 95, and 84%, respectively.
CONCLUSIONS: The prevalence of postablation thyroid cancer recurrence is predicted by the rhTSH-Tg response with an optimal Tg threshold of 2.5 ng/ml. Still, recurrent disease occurs in some patients with an initial rhTSH-Tg of 0.5 ng/ml or less.
Richard T Kloos
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Publication Detail:
Type:  Journal Article     Date:  2010-09-15
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-06     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5241-8     Citation Subset:  AIM; IM    
Department of Internal Medicine, The Ohio State University Medical Center, 446 McCampbell Hall, 1581 Dodd Drive, Columbus, Ohio 43210, USA.
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MeSH Terms
Aged, 80 and over
Autoantibodies / blood
Lymph Node Excision
Middle Aged
Neoplasm Recurrence, Local / blood,  diagnosis,  pathology,  prevention & control,  surgery*
Neoplasm Staging
Recombinant Proteins / blood
Thyroglobulin / blood*,  deficiency,  immunology
Thyroid Neoplasms / blood,  pathology*,  surgery*,  ultrasonography
Thyrotropin / blood
Reg. No./Substance:
0/Autoantibodies; 0/Recombinant Proteins; 9002-71-5/Thyrotropin; 9010-34-8/Thyroglobulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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