Horm Metab Res 2013; 45(12): 911-914
DOI: 10.1055/s-0033-1347264
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Follow-up of Patients with Low-risk Papillary Thyroid Carcinoma and Undetectable Basal Serum Thyroglobulin After Ablation Measured with a Sensitive Assay: A Prospective Study

P. W. S. Rosario
1   Postgraduation Program, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
,
J. B. N. dos Santos
1   Postgraduation Program, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
,
M. R. Calsolari
1   Postgraduation Program, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 24. März 2013

accepted 13. Mai 2013

Publikationsdatum:
11. Juni 2013 (online)

Abstract

The importance of thyroglobulin (Tg) stimulation after ablation in patients with papillary thyroid carcinoma (PTC) and undetectable basal Tg measured with sensitive assays has been questioned. However, there is a need for prospective studies that evaluate the evolution of these patients when stimulated Tg is omitted and this was the objective of the present investigation. One hundred twenty-two consecutive patients with PTC with the following characteristics were evaluated: submitted to total thyroidectomy and remnant ablation; low risk for recurrence; undetectable basal Tg (functional sensitivity of 0.1 ng/ml) 6 months after initial therapy; anti-Tg antibodies (TgAb) negative, and neck ultrasound (US) showing no abnormalities. These patients were not submitted to Tg stimulation. After follow-up for 24–78 months, only one patient (0.8%) presented apparent disease (lymph node metastases). TgAb were detected at low titers and without progression in 1 patient (0.8%). Tg became detectable and continued to be detectable in 3 patients (2.4%), but at concentrations ≤0.3 ng/ml in the absence of further increases, with stimulated Tg < 1.4 ng/ml. A total of 117 patients (96%) coursed with no apparent disease throughout follow-up and had undetectable Tg at the end of the study. Of these, 111 showed undetectable Tg in all measurements and 6 showed detectable Tg in some of them, although Tg later returned spontaneously to an undetectable range. After ablation, the risk of recurrence is very low in patients with low-risk PTC who show undetectable basal Tg measured with a sensitive assay, negative TgAb and negative US.

 
  • References

  • 1 Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214
  • 2 NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma version 1.2013 www.nccn.org
  • 3 Brassard M, Borget I, Edet-Sanson A, Giraudet AL, Mundler O, Toubeau M, Bonichon F, Borson-Chazot F, Leenhardt L, Schvartz C, Dejax C, Brenot-Rossi I, Toubert ME, Torlontano M, Benhamou E, Schlumberger M. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab 2011; 96: 1352-1359
  • 4 Giovanella L, Ceriani L, Ghelfo A, Maffioli M, Keller F, Spriano G. Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant thyrotropin stimulated assay and imaging procedures. Clin Chem Lab Med 2006; 44: 648-652
  • 5 Iervasi A, Iervasi G, Ferdeghini M, Solimeo C, Bottoni A, Rossi L, Colato C, Zucchelli GC. Clinical relevance of highly sensitive Tg assay in monitoring patients treated for differentiated thyroid cancer. Clin Endocrinol (Oxf) 2007; 67: 434-441
  • 6 Rosario PW, Purisch S. Does a highly sensitive thyroglobulin (Tg) assay change the clinical management of low-risk patients with thyroid cancer with Tg on T4 <1 ng/ml determined by traditional assays?. Clin Endocrinol (Oxf) 2008; 68: 338-342
  • 7 Spencer C, Fatemi S, Singer P, Nicoloff J, Lopresti J. Serum Basal thyroglobulin measured by a second-generation assay correlates with the recombinant human thyrotropin-stimulated thyroglobulin response in patients treated for differentiated thyroid cancer. Thyroid 2010; 20: 587-595
  • 8 Malandrino P, Latina A, Marescalco S, Spadaro A, Regalbuto C, Fulco RA, Scollo C, Vigneri R, Pellegriti G. Risk-adapted management of differentiated thyroid cancer assessed by a sensitive measurement of basal serum thyroglobulin. J Clin Endocrinol Metab 2011; 96: 1703-1709
  • 9 Castagna MG, Tala Jury HP, Cipri C, Belardini V, Fioravanti C, Pasqui L, Sestini F, Theodoropoulou A, Pacini F. The use of ultrasensitive thyroglobulin assays reduces but not abolishes the need for TSH stimulation in patients with differentiated thyroid carcinoma. J Endocrinol Invest 2011; 34: 219-223
  • 10 Chindris AM, Diehl NN, Crook JE, Fatourechi V, Smallridge RC. Undetectable sensitive serum thyroglobulin (<0.1 ng/ml) in 163 patients with follicular cell-derived thyroid cancer: results of rhTSH stimulation and neck ultrasonography and long-term biochemical and clinical follow-up. J Clin Endocrinol Metab 2012; 97: 2714-2723
  • 11 Giovanella L, Maffioli M, Ceriani L, De Palma D, Spriano G. Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma. Clin Chem Lab Med 2009; 47: 1001-1004
  • 12 Mazzaferri EL. Will highly sensitive thyroglobulin assays change the management of thyroid cancer?. Clin Endocrinol (Oxf) 2007; 67: 321-323
  • 13 Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med 2008; 46: 1067-1073
  • 14 McLeod DS. Current concepts and future directions in differentiated thyroid cancer. Clin Biochem Rev 2010; 31: 9-19
  • 15 Rosario PW, Faria S, Bicalho L, Gatti Alves MF, Borges MAR, Purisch S, Padrão EL, Rezende LL, Barroso AL. Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med 2005; 24: 1385-1389
  • 16 Durante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, Costante G, Meringolo D, Bruno R, Trulli F, Massa M, Maniglia A, D’Apollo R, Giacomelli L, Ronga G, Filetti S. on behalf of the PTC Study Group . Papillary thyroid cancer: time course of recurrences during postsurgery surveillance. J Clin Endocrinol Metab 2013; 98: 636-642
  • 17 Rosario PW, Mineiro Filho AF. Does undetectable basal Tg measured with a highly sensitive assay in the absence of antibodies and combined with normal ultrasonography ensure the absence of disease in patients treated for thyroid carcinoma?. Arq Bras Endocrinol Metabol 2012; 56: 149-151
  • 18 Rosario PW. Ultrasonography for the follow-up of patients with papillary thyroid carcinoma: how important is the operator?. Thyroid 2010; 20: 833-834
  • 19 Cailleux AF, Baudin E, Travagli GP, Richard M, Schlumberger M. Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer?. J Clin Endocrinol Metab 2000; 85: 175-178