Sequential Follow-up of Serum Thyroglobulin and Whole Body Scan in Thyroid Cancer Patients without Initial Metastasis

Abstract

It is most informative when both the trend and the levels of Tg during sequential follow-up are considered. The diagnostic WBS may be performed for selected patients with indication based on Tg levels to localize the disease.

Thyroglobulin as early prognostic marker to predict remission at 18–24 months in differentiated thyroid carcinoma

“…Although current guidelines suggest that initial treatment should be evaluated at 6-12 months after total thyroidectomy and RAI-RA, 14 we decided to evaluate effectiveness at 18-24 months, as several studies have shown serum Tg levels can decline for many years after treatment. [16][17][18][19][20][21] One recent study shows that only 75% of patients achieve their nadir Tg at 1 year after initial therapy, and the remaining 25% have a nadir Tg more than 1 year after RAI-RA. 25 To our knowledge, this is the first study that evaluates baselinestimulated Tg as early prognostic marker of remission of disease at 18-24 months.…”

“…14,15 Several other studies, however, have demonstrated that serum Tg levels can decline progressively for many years after RAI-RA. [16][17][18][19][20][21] One recently published article found that around 25% of patients required 18 months or longer for Tg to become undetectable even though they were cured. 22 This point is important to keep in mind when determining the time course of the disappearance of Tg after initial therapy.…”

“…It could avoid unnecessary diagnostic testing and empiric therapies in patients who are likely to eventually develop undetectable Tg values. [16][17][18][19][20][21] Other Tg values at different time points during follow-up have been investigated, such as baseline Tg, defined as stimulated Tg after surgery and immediately before radioiodine treatment. Baseline Tg could be an early marker to identify both remission and high-risk patients.…”

The Role of Routine Diagnostic Radioiodine Whole-Body Scintigraphy in Patients with High-Risk Differentiated Thyroid Cancer

“…Still, the authors concluded that routine DxWBS might be omitted in high-risk patients just as in low-risk patients (12). Other studies have found that in their study population, which also included high-risk patients, DxWBS had no value additional to that provided by stimulated thyroglobulin measurement (12)(13)(14)(15)(16)(17).…”

Reply: Utility of Diagnostic Whole-Body Iodine Scanning in High-Risk Differentiated Thyroid Carcinoma

“…Several studies analyzed the additional value of DxWBS, but also in low-risk patients (3)(4)(5)(6)(7)(8)(9)(10). Most studies found no additional value of DxWBS in their patient group (3)(4)(5)(6)(7)(8)(9).…”