A Review of TENIS syndrome in Hospital Pulau Pinang

Abstract

Introduction:The treatment for differentiated thyroid cancers (DTCs) has always been radioactive iodine 131I therapy after definitive surgical management. Clinicians are faced with therapeutic challenges when dealing with patients having thyroglobulin-elevated negative iodine scintigraphy (TENIS) syndrome (elevated serum thyroglobulin [Tg] levels but negative whole-body scans [WBSs]).Objective:The aim of the study was to determine the prevalence of TENIS syndrome in our local setting and to evaluate the use of 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in the management.Methodology:The data from DTC patients treated in the Department of Nuclear Medicine, Hospital Pulau Pinang from December 1, 2010, to November 30, 2016, with negative WBS and elevated Tg were reviewed. These patients should have undergone 18F-FDG PET-CT to be included in the study.Results:Only forty (10.4%) out of a total of 386 patients treated in Hospital Pulau Pinang during the study fulfilled the inclusion criteria. There were 28 women (70%) with median age of 59 years old. Thirty-four patients (85%) had papillary thyroid cancer (PTC) and six patients had follicular thyroid cancer. The use of 18F-FDG PET-CT revealed 23 patients (57.5%) with 18F-FDG avid metastases suggesting dedifferentiation of thyroid cancers. Based on this study, the probability of detecting FDG-avid disease is higher (P = 0.03) if 18F-FDG PET-CT was performed when Tg ≥15 ng/mL.Conclusion:TENIS syndrome constitutes a significant number of cases in our setting. Our data suggest a cutoff Tg ≥15 ng/mL for performing 18F-FDG PET-CT for these patients would be more beneficial than the currently American Thyroid Association recommended cutoff of 10 ng/mL.

PET/CT with ¹⁸F-FDG for TENIS Syndrome in a Patient with Bone Metastasis of Hurthle Cell Thyroid Cancer: a Clinical Case Report

“…TENIS-синдром характеризуется наличием высокого уровня тиреоглобулина и отсутствием патологического накопления радиоактивного йода при сканировании. Наблюдается в 10,4 % случаев и ухудшает прогноз заболевания [10]. При установлении TENIS-синдрома, в определении дальнейшей тактики лечения необходимо проведение ПЭТ/КТ с 18 F-ФДГ, так как данный метод обладает высокой чувствительностью к радиойодрефрактерным очагам и, по литературным данным, в 20-40 % случаев кардинально меняет тактику лечения пациента.…”

Clinicopathological features and outcome of thyroglobulin elevation and negative iodine scintigraphy (TENIS) patients with negative neck ultrasound: Experience from a thyroid carcinoma clinic in India

“…This is referred to as Tg elevation and negative iodine scintigraphy (TENIS) syndrome and is seen in 10%–27%. [ 1 2 ] This causes considerable diagnostic and therapeutic dilemma. In such patients, ultrasound (US) neck helps in identifying local disease which can be managed appropriately and may sometimes even eliminate the need for empiric radioactive iodine therapy (eRAI).…”

Diagnostic Performance of [18F]TFB PET/CT Compared with Therapeutic Activity [131I]Iodine SPECT/CT and [18F]FDG PET/CT in Recurrent Differentiated Thyroid Carcinoma

“…However, the low signal-to-noise ratio and the low spatial resolution of WBS-SPECT/CT in combination with [ 131 I]iodine limit their sensitivity. This issue may cause the “thyroglobulin elevated and negative scintigraphy” (TENIS) syndrome ( 7 ). In addition, [ 131 I]iodine as a β-emitter involves comparably high radiation exposure ( 8 ).…”